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SO# <br /> C1/Q __0W r' Site# <br /> MONITOR WELLS <br /> Well Number 1 2 3 4 5 6 7 a 9 10 11 12 <br /> Well De th <br /> De th to Water <br /> Product Detected <br /> AMOUNT in inches <br /> Standard Symbols for diagram below: tJF Fill <br /> OV Vapor Recovery <br /> V.R. w / Ball Float M Monitor Well li <br /> a <br /> Observation Well <br /> (Outside Tank Bed Area) (Inside Tank Bed Ares <br /> B Ball Float Tank Gauge O Vent } <br /> M Manway Iron Cross <br /> �T Turbine <br /> Location Diagram—Include t e Vapor Recovery System. <br /> .. . . . . . . . . <br /> . . . . . . . . . . . . . . . fi <br /> .z <br /> . . . . . . . . . . a ' <br /> . . . . . . . . . . . . <br /> Vapor Recovery System & Vents were tested with which tank? <br /> Parts and Labor used <br /> General Comments <br /> When OWNER or local regulations require immediate reports of system failure-Complete the following: <br /> REPORTED hIAME DATE TIME <br /> TO: <br /> Phone# OWNER or Regulatory Agency FILE NUMBER' <br /> Print: Certified Testers Name C,777 V41 W. LU�#IIAT Vacutectrm Ce kation Number <br /> OT31: 091-1128 <br /> Certified Testers Signature Date Testing Completed <br /> Farm-TRnkMLlrrrGfSA1 <br />