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M <br />Deptli <br />Water <br />NOT Det.0 <br />0 <br />:000 <br />U a <br />k <br />Da <br />• Labor used <br />General Comments <br />" nen local regulations require immediate reporting of a system leak-C-omplete the following: <br />Reported <br />Name Date Time <br />Phone Number Regulatory Agency s File Number <br />Print: Certified Testers Name Vacutect(tm) Certification Number <br />Certified Testers Signature Date Testing Completed For=TestData 1/89 <br />