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. �.Frod '1�et •, <br />• '� tem-Cvrat. <br />Piecl:t:a'{cal Ler1}S Detect®r 1t�,l,u.`acturer: <br />[ ] RJ Slow Flow <br />[ ] RJ Shut Off <br />LLQAgi: A, <br />Status @ Arrival: [ ] <br />Corrective Action: operational <br />a [ ] 14011—operational <br />Departure: [ , 1 atmecl [ ] Required <br />[ ) opererational [ ] 11011-0perational <br />rite O 1 2Lqjj&RRAI oring, Svstew <br />TYPE <br />[ ] Visually Monitored (Daily <br />[ site well Vapor Probes <br />[ ] 111terstitial Monitor <br />Inventory) <br />[ ) wet <br />lianufacturer: [ J AP -L <br />[ ] Leakalert [ J Pollualert <br />odel: <br />[ ) Other <br />[ ) OC reservoir <br />status 0 Arrival: ( ) ot)erational <br />Corrective Action: [ J Performed [ , 18011-operatiol,al <br />Status 0 Departure: [ J Operational [ ) Required <br />[ ) 11011 -operational <br />I do certify that <br />representative of <br />the <br />the <br />above <br />actual <br />informatio„ <br />alld <br />operatil,q status <br />col,aitioll of <br />the <br />mol,itoring systemic <br />Signatures <br />- I �-7 e 111-elx�-.t' z1 <br />compally (/ <br />_ 77 a6 `i/ <br />Date <br />