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P <br />Z C <br />O <br />to ° <br />N <br />V N <br />ow <br />:y Cl <br />rp] n <br />O <br />q <br />9 <br />N C7 <br />N <br />T CT! <br />@- <br />o m <br />n <br />On <br />Q <br />a <br />si ar <br />p c,W <br />y o <br />m <br />m <br />m <br />3 <br />C47 <br />-n <br />m <br />30 <br />m <br />a <br />Al rn <br />C <br />�`!U° <br />n <br />o <br />rn <br />° <br />At <br />0 <br />m <br />��o� <br />ie <br />r <br />w <br />r <br />A <br />m <br />n <br />m <br />m <br />Is the water over the tank? <br />Depth to the Water table .�_ ElYes M No <br />m <br />o.x <br />_ <br />m <br />3 <br />0° <br />n <br />33 <br />n rT€ <br />a <br />m <br />- <br />-{ <br />T <br />f <br />a <br />ro <br />n <br />C <br />❑ <br />° <br />10. OTHER <br />INFORMATION <br />OR REMARKS <br />m <br />m <br />>�� <br />W <br />11. TEST RESULTS <br />m <br />3 <br />n ' 3 <br />v <br />n <br />12. SENSOR <br />CERTIFICATION <br />13. TNN is to certify that these tank systems w"a tested on the date(s) shown. Those Indicated as 'Tight" meet the criteria <br />Nailonal Flre Protection Assodation Pamphlet 321 <br />Technto / <br />t ♦VVgq- <br />Testing Contractor or Company. By: Signature <br />Certification x <br />M <br />m <br />Al +3 <br />�Q <br />M <br />El <br />w <br />n <br />o <br />--i m <br />t <br />z <br />- <br />o t t v <br />N <br />Cn <br />n <br />E K� <br />�a <br />v n <br />n <br />s <br />0 <br />£ <br />Ute] <br />Z <br />N <br />M <br />U] <br />n <br />u <br />eC1 <br />y <br />m ' <br />d <br />CD <br />i <br />w <br />N <br />° <br />n <br />rn <br />'m <br />c� <br />O- <br />a <br />o <br />N <br />0 <br />�m &� <br />J <br />a <br />v <br />C <br />v1 <br />< <br />me <br />M <br />x <br />u <br />Cn <br />El�. <br />CP <br />o <br />C7 <br />a <br />_ <br />_ <br />Co <br />r„ <br />cn <br />Cn <br />O <br />a <br />ow <br />Name Address fiepresentative Telephone <br />ru <br />n x <br />C1 <br />Name Address Telephone <br />n <br />D <br />if <br />T <br />= <br />- <br />3 <br />si ar <br />m <br />y o <br />m <br />m <br />° <br />d� <br />10 <br />C�� <br />C47 <br />-n <br />m 70 <br />Fa n n <br />w c m <br />V 1 <br />a- <br />C <br />�`!U° <br />n <br />rrri Q <br />rn <br />° <br />o <br />m <br />r <br />m <br />r <br />C7 rn <br />p <br />Slphones <br />Which tanks? <br />a <br />m <br />Is the water over the tank? <br />Depth to the Water table .�_ ElYes M No <br />_ <br />o �' <br />a o <br />H <br />33 <br />"y <br />- <br />-{ <br />T <br />f <br />a <br />ro <br />n <br />C <br />❑ <br />° <br />10. OTHER <br />INFORMATION <br />OR REMARKS <br />7 <br />>�� <br />W <br />11. TEST RESULTS <br />m <br />3 <br />m y <br />n <br />12. SENSOR <br />CERTIFICATION <br />13. TNN is to certify that these tank systems w"a tested on the date(s) shown. Those Indicated as 'Tight" meet the criteria <br />Nailonal Flre Protection Assodation Pamphlet 321 <br />Technto / <br />t ♦VVgq- <br />Testing Contractor or Company. By: Signature <br />Certification x <br />established by the <br />++ gg Date <br />r'37�Y�y <br />Serial No. of Thermal No. of Thermall <br />�Q <br />M <br />El <br />w <br />--i m <br />t <br />z <br />- <br />o t t v <br />2 y� <br />Cn <br />n <br />E K� <br />�a <br />v n <br />n <br />s <br />0 <br />£ <br />Z <br />N <br />M <br />U] <br />n <br />Cl <br />m <br />u <br />eC1 <br />y <br />m ' <br />d <br />CD <br />i <br />w <br />N <br />° <br />n <br />rn <br />'m <br />O- <br />a <br />o <br />N <br />�m &� <br />J <br />a <br />v <br />C <br />v1 <br />< <br />me <br />M <br />u <br />Cn <br />El�. <br />(O <br />a <br />_ <br />s <br />r„ <br />cn <br />Cn <br />0 <br />x <br />o <br />o <br />UUi <br />d <br />o <br />rno <br />x- <br />.-t z <br />7C <br />v <br />❑Cn <br />W <br />m <br />o <br />o <br />m <br />mn <br />m <br />g <br />U) <br />C3Dom <br />M <br />x <br />n <br />m <br />rn <br />a <br />a <br />a <br />m <br />M <br />M <br />° <br />r <br />n <br />o <br />o <br />m <br />m <br />x <br />o <br />G3 <br />p <br />CD <br />m <br />o. <br />n <br />er <br />N <br />j <br />r <br />Y <br />C <br />0 <br />r <br />a <br />Z <br />° <br />Name Address fiepresentative Telephone <br />Name Address Representative Telephone <br />n x <br />n <br />Name Address Telephone <br />n <br />C"l <br />D <br />ti n <br />j:E <br />b O O <br />Ui n <br />m Lm K <br />��J�����FtL0i 1��TofZ���N V I�eN�in����0 N CC wor-�7/-0 <br />y o <br />m <br />m <br />° <br />d� <br />10 <br />C�� <br />C47 <br />-n <br />m 70 <br />Fa n n <br />w c m <br />V 1 <br />a- <br />C <br />�`!U° <br />n <br />rrri Q <br />° <br />o <br />m <br />r <br />m <br />r <br />C7 rn <br />p <br />Slphones <br />Which tanks? <br />a <br />m <br />Is the water over the tank? <br />Depth to the Water table .�_ ElYes M No <br />O <br />u _- - <br />o �' <br />A/?eel¢_. f Ai <br />Tanks to 6e filletla PO4 hr. T -� Date Arranged 4y ._._.. e ��, <br />Nam <br />Extra product to 'lop off' and nun tank tester. How and who to provida? Consider NO Lead. <br />a <br />� <br />33 <br />� <br />- <br />-{ <br />Ong. <br />,°� <br />m : x n <br />p r1"1 <br />77 <br />C7 <br />❑ <br />10. OTHER <br />INFORMATION <br />OR REMARKS <br />>�� <br />W <br />11. TEST RESULTS <br />n <br />W IF ST`It- C <br />12. SENSOR <br />CERTIFICATION <br />13. TNN is to certify that these tank systems w"a tested on the date(s) shown. Those Indicated as 'Tight" meet the criteria <br />Nailonal Flre Protection Assodation Pamphlet 321 <br />Technto / <br />t ♦VVgq- <br />Testing Contractor or Company. By: Signature <br />Certification x <br />established by the <br />++ gg Date <br />r'37�Y�y <br />Serial No. of Thermal No. of Thermall <br />�Q <br />M <br />El <br />w <br />--i m <br />t <br />z <br />- <br />o t t v <br />2 y� <br />Cn <br />n <br />E K� <br />v n <br />Cn <br />0 <br />- <br />N <br />M <br />U] <br />n <br />Cl <br />m <br />u <br />eC1 <br />2Z <br />❑ <br />i <br />w <br />'m <br />O- <br />N <br />�m &� <br />J <br />a <br />v1 <br />a <br />� Im <br />m <br />W n <br />M <br />n <br />T1 Z <br />t o <br />n <br />�O N <br />n <br />x <br />"!1 <br />r'r1 <br />t - <br />O <br />va] <br />Z <br />° <br />Name Address fiepresentative Telephone <br />Name Address Representative Telephone <br />2. OPERATOR <br />n <br />Name Address Telephone <br />n <br />C"l <br />m� <br />4. WHO REQUESTED <br />TEST AND WHEN <br />��J�����FtL0i 1��TofZ���N V I�eN�in����0 N CC wor-�7/-0 <br />y o <br />Dale <br />Address <br />Telephone <br />n. <br />M <br />ih <br />4 <br />e <br />V 1 <br />n <br />SOF-wt- 1G' Opb <br />� Im <br />m <br />W n <br />M <br />n <br />T1 Z <br />t o <br />n <br />�O N <br />n <br />x <br />"!1 <br />r'r1 <br />t - <br />O <br />va] <br />Z <br />° <br />Name Address fiepresentative Telephone <br />Name Address Representative Telephone <br />2. OPERATOR <br />n <br />Name Address Telephone <br />n <br />C"l <br />m� <br />4. WHO REQUESTED <br />TEST AND WHEN <br />��J�����FtL0i 1��TofZ���N V I�eN�in����0 N CC wor-�7/-0 <br />Name Title Company or Affiliation <br />Dale <br />Address <br />Telephone <br />5. TANK INVOLVED <br />Use additional lines <br />for manifolded tanks <br />Identify by Direction Capacity <br />YY,95-` 4 000 <br />Brand/Supplier Grade <br />or --4SOr- get 1!�- exec' <br />Approx,ge <br />5 ee Fiberglass <br />r <br />SOF-wt- 1G' Opb <br />r <br />❑❑❑❑�3 <br />Location Cover <br />lvice-PAAAAE''a" <br />IW* dc�^llecKwyy-t <br />North inside driveway, Concrete, Black Top, <br />Rear of station, etc. Earth, eta <br />Fills Vents <br />Size, Tteflll make. Drop <br />tubes, Remote Fills Size, Manlfolded <br />Slphones <br />Which tanks? <br />m w <br />7. UNDERGROUND <br />WATER <br />Is the water over the tank? <br />Depth to the Water table .�_ ElYes M No <br />a <br />y � � <br />Cl <br />3 <br />A/?eel¢_. f Ai <br />Tanks to 6e filletla PO4 hr. T -� Date Arranged 4y ._._.. e ��, <br />Nam <br />Extra product to 'lop off' and nun tank tester. How and who to provida? Consider NO Lead. <br />a <br />� <br />C <br />j � � <br />7 <br />� c <br />� <br />m m <br />9. CONTRACTOR, <br />MECHANICS, <br />any other contractor <br />involved <br />s <br />q w <br />w <br />W <br />bdta Chart for Tank Systum Tightness Test <br />PLEASE PRINT <br />1. OWNER Property Li(.1 <br />Tank (s. <br />11,0R*r j #/er YI SG e..4-ryA . /('t ticks/O6 64 (7,t V) 369 -dost <br />Name Address fiepresentative Telephone <br />Name Address Representative Telephone <br />2. OPERATOR <br />`7v �OSE,t� .� coq <br />Name Address Telephone <br />3, REASON FOR <br />TEST <br />(Explain Fully) <br />N N Sr- <br />TTEST <br />4. WHO REQUESTED <br />TEST AND WHEN <br />��J�����FtL0i 1��TofZ���N V I�eN�in����0 N CC wor-�7/-0 <br />Name Title Company or Affiliation <br />Dale <br />Address <br />Telephone <br />5. TANK INVOLVED <br />Use additional lines <br />for manifolded tanks <br />Identify by Direction Capacity <br />YY,95-` 4 000 <br />Brand/Supplier Grade <br />or --4SOr- get 1!�- exec' <br />Approx,ge <br />5 ee Fiberglass <br />r <br />SOF-wt- 1G' Opb <br />8. INSTALLATION <br />DATA <br />Location Cover <br />lvice-PAAAAE''a" <br />IW* dc�^llecKwyy-t <br />North inside driveway, Concrete, Black Top, <br />Rear of station, etc. Earth, eta <br />Fills Vents <br />Size, Tteflll make. Drop <br />tubes, Remote Fills Size, Manlfolded <br />Slphones <br />Which tanks? <br />Pumps <br />Suction, Remote, <br />Make if known <br />7. UNDERGROUND <br />WATER <br />Is the water over the tank? <br />Depth to the Water table .�_ ElYes M No <br />8. FILL -UP <br />ARRANGEMENTS <br />A/?eel¢_. f Ai <br />Tanks to 6e filletla PO4 hr. T -� Date Arranged 4y ._._.. e ��, <br />Nam <br />Extra product to 'lop off' and nun tank tester. How and who to provida? Consider NO Lead. <br />�F,r� <br />��d4 �n <br />Telephone <br />Terminal or other contact p{ <br />for or inquiry - <br />notice <br />Company Name <br />Telephone <br />9. CONTRACTOR, <br />MECHANICS, <br />any other contractor <br />involved <br />10. OTHER <br />INFORMATION <br />OR REMARKS <br />Additional information on any Items above. Offlcia€s or others to be advised When testing is in progress or completed. Visitors or observers present during test, etc. <br />11. TEST RESULTS <br />Tests were made on the above tank systems In accordance with test procedures prescribed for <br />as detailed on attached test charls with results as follows: <br />Tank identification Tight Leakage Indicated Date Tested <br />W IF ST`It- C <br />12. SENSOR <br />CERTIFICATION <br />13. TNN is to certify that these tank systems w"a tested on the date(s) shown. Those Indicated as 'Tight" meet the criteria <br />Nailonal Flre Protection Assodation Pamphlet 321 <br />Technto / <br />t ♦VVgq- <br />Testing Contractor or Company. By: Signature <br />Certification x <br />established by the <br />++ gg Date <br />r'37�Y�y <br />Serial No. of Thermal No. of Thermall <br />Cert€ilcalion of <br />Addrma <br />PN6827 <br />