Laserfiche WebLink
DATA CHART DIALYSIS NORTH <br />For Use With P.O. BOX 95 BELLA VISTA, CA, 96008 530-275-66E <br />Petro TlP <br />S'T�c�TvN , CA <br />LOCATION LA^/LI(j== I2u c.K in1�S b{ /S2 ric Nu <br />ta.p-- <br />non . No <br />2 OWNER / JA• L <br />N.m. Aod,.ff <br />uoLSet,, olL NC lUl- <br />3 OPERATOR. 1N—�_ <br />D..l.i. Md, or 01h.i Add-tt lil drll.r.nl In.n lnc.ltn�! .i.Dnon. No <br />4 REASON FOR TEST _ /1 �JN�L A, L- Li N(.a- 7QS 7- <br />6 <br />6 TEST REQUESTED BY: WLkLfEz E L V W e- — <br />fmf Pos,Aon O,d., No, BllllnQ Add,.tf <br />6 SPECIAL INSTRUCTIONS: <br />7 CONTRACTOR OR COMPANY MAKING TEST /��%�� <br />MECHANIC(S) NAME t l A �') 3 Un? SS �— e-3--( <br />8 IS A TANK TEST TO BE YES 9 MAKE AND TYPE OF �1— <br />MADE WITH THIS LINE TEST? PUMP OR DISPENSERS <br />NO <br />C COVER APPROXIMATE <br />10 WEATHER Sou NL'1 TEMPERATURE IN TANKS 'F 'C OVER LINES �uLK-Gj�3 BURIAL DEPTH Gf <br />fn�c,elt. Rlfc. Too. fIc <br />11 IDENTIFY <br />EACH LINE <br />AS TESTED <br />12 TIME <br />(MILITAR Y) <br />13 LOG OF TEST PROCEDURES, <br />AMBIENT TEMPERATURE, <br />WEATHER. ETC. <br />14 PRESSURE <br />15 VOLUME <br />16 TEST RESULTS <br />psi OR kPa <br />READING <br />BEFORE AFTER <br />NET <br />CHANGE <br />M <br />CONCLUSION$, REPAIRS AND COMENTS <br />BEFORE <br />AFTER <br />>56Z P9ucr 4►mac <br />c tor:�) �Pcxe a, �� <br />7r ZEL <br />10' 15 <br />-FA rt <br />ro : <br />L��� — <br />47 <br />sa <br />, 0/ <br />0 140_ <br />cv , 45 <br />L i N� T -T <br />_ <br />11'.00 <br />_ '50 <br />I <br />_U __ <br />,c)//v ..0090 <br />, vlJ90 __I <br />, asfo <br />-,0620 <br />f, v�9_v___ <br />/1, t 20 <br />13,4cI< C'tf1Zk <br />