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0 0 # 21000 <br /> bp AL <br /> WORK ACKNOWL <br /> a.0s EDGEMENT FORM IFF <br /> "��0-7�t A-57Z <br /> E-MAINTENANCE TICKET NO: DATE: j(/ <br /> FACILITY NO.&ADDRESS:-541.570 T-remo.� Ciq <br /> GMTLER-RYA1q M <br /> VENDOR NAME&ADDRESS: 6747 SIERRA CD=STILI <br /> SERVICE REQUESTED: "WVLA111* <br /> �I TANKUNE TIGHTNESS TEST LJ FACILITY INSPECTION Ll ENVIRONMENTAL REPAIRS <br /> LJ VOOR RECOVERY TEST U SECONDARY CONTAINMENT TESTING 4 OTHER Swk, <br /> U ALARM TYPE AS LISTED ON VEEDER-ROOT PANEL V rk <br /> LOCATION OF ALARM Q SUMP NO. Ll UDC/DISPENSER NO. U ANNULAR TANK NO. <br /> ALL ALARMS CLEARED Ll Y U N <br /> PLEASE PRINT LEGIB 0 31 <br /> x <br /> x <br /> Are all sensor(s)located at the lowest point? Chain attached to shear valve? Debris removed from UDC? <br /> J Y Ll N Q NA L3 Y UN U NA UY UN LINA <br /> Have all sump lids and dispenser panels been U ECS Notified of liquid found in Vapor equipment repairs <br /> secured and sealed? 13 Y Q N LJ NA containment sumps documented in Repair Log? <br /> �A only if no sumps or dispensers were opened. U Y LJI N IJ NA <br /> NUMBER OF PERSONNEL F ARRIVAL TIME DEPARTURE TIME /3 0 <br /> TOTAL HOURS (MINUS MEALS) <br /> TECHNICIAN PRINT NAME NAME OFD L MANAGER <br /> TECH SIGNATURO SIGNATURE OF DEALER/MANAGER <br /> DISTRIBUTION:WTE-Invoice copy I CANARY-Site copy/ PINK-Vendor copy <br />