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SO# //5 50 CIser: t).47,-,eM Site# <br />Well Number 1 2 1 3 4 <br />5 8 <br />7 <br />8 9 <br />10 <br />11 <br />12 <br />Well Depth /3o is <br />Depth to Water <br />Product Detected <br />AMOUNT in inches <br />Standard Symbols for diagram below: <br />/B V.R. w / Ball Float <br />© Ball Float <br />M Manway 1 <br />@F Fill <br />Monitor WellO <br />(Outside Tank Bed Area) <br />Tank Gauge <br />Iron Cross <br />Vapor Recovery <br />Observation Well <br />® (inside Tank Bed Area) <br />O Vent <br />®Turbine <br />Location Diagram—Include the Vapor Recovery System. 1111"In-ee /a.vt <br />............................. <br />............................. <br />.............................. <br />�C COQ . �.. . . . . . . <br />�n . . . . . . . <br />0 it . r . . . . . <br />H <br />loo x ® <br />SOA/ . . . 1 lO'QL <br />le 1z 0 .A/. [D I - - - /vcvo <br />. HH <br />4 <br />. . . . . . . . . . . . . . . . . . . . <br />. . . . . . . . . . . . . . . . . . . . <br />. . . . . . . . . . . . . . . . . . . . <br />. . . . . . . . . . . . . . . . . . . . <br />Vapor Recovery System & Vents were tested with which tank? <br />. . . <br />. . . [�?1 <br />/� <br />. . . . . . . . . <br />. . . . . . . . . <br />. . . . . . . . . <br />. . . . . . . . . <br />Parts and Labor used <br />General Comments <br />e� <br />When OWNER or local regulations require immediate reports of system failure -Complete the following: <br />REPORTED <br />TO: <br />NAME <br />DATE <br />TIME <br />Phone# <br />OWNER or Regulatory Agency <br />FILE NUMBER <br />Print Certified Testers Name <br />pe,4A) � r <br />Vacu Ce catbn NumSer <br />Certified Testers Sig <br />Date Testing Completed <br />Y_ <br />Fant-TaMNLix96PWD1 <br />