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Site Plumber -7/ Date �� <br /> oboe IT"* Step C'Type �pw sysb- E'er a <br /> Enhanced Vapor <br /> VA-Vac Assist Dues the site CAS=Healy Clean Air Separator Recovery �) <br /> 2P=Two Point BL=Balance have a mor VR=VR Carbon Canister J U L q C 018 <br /> t <br /> CP-Coax poppeted VST-Vapor Sys Tech pot(drop <br /> out VST=VST Vapor Processor �=EBW VR <br /> CN=Coax Non•poppetad HEVR=Healy WEVR List any other PT=PHIL T1TE <br /> NA=No Stage t NA o Outside of Callfomta OPW=OPW VR <br /> Yea or No 14A No EVR ENVIRONMENTAL <br /> L V HEALTH DEPARTMENT <br /> Vapo.It---y System <br /> Tank# ftaraslt VentPipas Vein cops <br /> Proper Operating Are the vent Impact Protection OPW Condition <br /> fs there a separate vert for CondUon H=Husky <br /> Order Condroon each tank poes M-Morrison Bros <br /> per tank manifoldel B=Bollards Model# OK=Good condition <br /> OK=Sears NA=No Vent <br /> monitor Yes or No Yes or No together? A=36'from curb NS=Not secure mantfoided NC=Not in good coed. <br /> NA=No dry break Yes or No N=Norm NA-No went cap <br /> t <br /> NO=No VeN Present-� <br /> r4 2 <br /> T <br /> 5 <br /> 6 <br /> US171111106110ring System <br /> Y 'tl oM Number Prhtter Tank Pnobee So&rare Version <br /> VR=Veedi3 Root Does the on a probes f not ed and yV�are the tank probes instated? <br /> R=Ronan Monitor have a notes on to Bre system?y not provide F=Fal Surnp <br /> 1=Irrcm Write Madel Number P�� notes our bung avotes below. <br /> b arty other T=Turbine Sump rite software Vesico' <br /> N=None Install notes below. Other explain spew proved <br /> Other fist Yes or No Yes or No NA=No probes <br /> vlQ -756 `� z o <br /> Tai s p s nn srmrp b staaea Sana sm <br /> htp Coe�On FM--p 6 rt S fy 1001111 °r m"Omni Nw6ar Lia <br /> W=Water present If sensor is htstalied,is 4 If plate is In place and in proper <br /> Intact and in proper condition present in sump,is it b <br /> Order CS=C—tairunentSu mp (explain In commards below) F=Fuel present al Bee lowest print proper condition? condition <br /> per tank SB=Ridged Sal BannerYes or No D=Deters present <br /> = Fit Sump CD= all lean <br /> and Dry Yes or No Yes us No <br /> monitor N=None NA No <br /> (Circle lI re!apply) fU1=No Sensor NA=NO Yescr grate <br /> NA=No(dl sump ump <br /> t C-5 <br /> W F D (I�p A9 <br /> 2 CSW F 0 . VF <br /> 3 / „�i C W F D <br /> vle <br /> 4 t W F D CD CI <br /> 5 W F D CD <br /> 6 W F D CD <br /> Comments on any damageMeteclive equipment_ <br /> issued 12/27/2017 Page 2 of 10 <br />