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Project Name_ F (Lwplb:) t } bRLL VAIXE <br />41 Inspector's Name 5yNtt_ KlSHMAni I ENGINEERING <br />Unit Tested t, MU -WEST' <br />Date $-2-1-16 4 g -z8 r16 <br />ANNUAL LCRS CONTINUITY TEST INSPECTION <br />(A) TRACER DYE PRE -TESTING PHASE <br />1. Is the LCRS sump pumped for liquids prior to testing? yes-4—no <br />2. Was a pre -testing LCRS sample collected for observation? yeses_ no <br />3. If the sump was not pumped prior to testing, state reason: NA <br />4. Is the entry port free and clear of accumulated debris? yes no <br />5. Are any repairs needed to the port prior to LCRS continuity testing? yes no }� <br />6. Total number of ports that require repair: <br />7. If repairs are required to the entry port, complete a Maintenance Work Order (MWO). <br />Comments: do ✓ta <br />(R) TRACER DYE INJECTION PHASE <br />Tracer Dye Used : ��e V O.i L T -Y- rnr T) Unit: UJ M w t:sT <br />taut time of tracer dye injection: oq 273- Tank Start Reading (gal.).- <br />Stop <br />gal.): <br />Stop time of tracer dye injection: 10 O 2 Tank Stop Reading (gal.): <br />Total volume of tracer dye mixed (ml) : go ML <br />Total volume of tracer dye solution injected in the unit (gallons):_ <br />Average flow rate of injected tracer dye solution (gallons per min.): <br />Comments: J4 walt <br />Remedial Action <br />ufZL,o die of y <br />2 0 0 q eq&vt <br />Work Order I Date Completed' <br />Signature of Inspector 4hr--� <br />r <br />Page 1 of 2 <br />2oa, p <br />5617 <br />ONNOT&I <br />rii�ii <br />X 'acv <br />Signature <br />