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Ael <br /> SSiteGor°��G�C <br /> Tei,n6 <br /> . <br /> IT ELLS <br /> well Number 1 2 3 4 5 6 7 8 9 10 11 12 . <br /> Well Depth <br /> Depth to Water <br /> Product Detected <br /> AMOUNT in inches <br /> Standard Symbols for diagram below: F Fill V Vapor Recovery <br /> /s V.R. w / Ball Float ® Monitor Well �p Observation Well <br /> (Outside Tank Bed Area) (inside Tank Bed Area) <br /> © Ball Float ® Tank Gauge O Vent <br /> Manway I Iron Cross T Turbine <br /> Location Diaarm7lnclude the Vapor Recovery System. " <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> . . . . . . . . . . . . . C`?L� . -.��`� . . . . . <br /> . . . . . . . . . . . . . / ,Pini . . . . . . <br /> . . . . . . . . . <br /> 9 <br /> . . . . . . . <br /> . . . . . . ..oath, 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 /> SPORTED NAME DATE TIME <br /> Phone# OWNER or egulatory Agency FILE NUMBER <br /> Pnnt:COfled Testers Name acu;; cation umber <br /> -__5 <br /> a.a,) 64!f�' I <br /> Certified Testers Signature ._.. _ Date Testing Completed <br /> r�- <br />