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A KNOLOQ • VacuTect"m TEST REPORT <br />yy <br />�-o <br />TlC11110LOOY F0r1 TAAgI� <br />AND THEN ONMOIM= Q (� S.O. # �JJ <br />Owner l "✓� �j <br />Slte � Date <br />Invoice Name/Address Phone <br />Site Name/Address V "" �� �+,�`� \ HCl ( " ' Attn: <br />TANKNOLOGY Region G1I� <br />9� � Unit # � State Lic. # State: GO - <br />:NOTE: Original VacuTect Data recordings are reviewed by Tanknology's Audit Control Department and maintained on file. <br />TAK-01 <br />Tanknology Corporation International <br />5225 Hollister St., Houston, TX 77040 <br />(400) 888-8563 9 FAX (713) 690-2255 <br />TANKS <br />LINES <br />Leak Det <br />See <br />Diag. <br />For <br />Loc' <br />Tank <br /># <br />Tank <br />Product <br />Tank <br />Capacity <br />Tank <br />Dla.B <br />Material <br />ST/ <br />FRP/. <br />Lined <br />Dipped <br />Water <br />Level <br />■ <br />START <br />END <br />Dipped <br />Product <br />Level <br />■ <br />START <br />END <br />Probe <br />Water <br />Level <br />■ <br />START <br />END <br />Water <br />Ingress <br />Detected <br />■ <br />Yes/No <br />Bubble Ultage TANK <br />Ingress Air ■ <br />Detected Ingress Tight <br />■ Detected or <br />Yes/No ■ Fail <br />Yes/No <br />Line # <br />Line <br />Material <br />INSyst. <br />ST/ <br />FRP <br />Line <br />Delivery <br />Type <br />■ <br />PS/SS/GS <br />LINE <br />TEST <br />■ <br />START <br />TIME <br />LINE <br />TEST <br />■ <br />END <br />TIME <br />Final <br />Leak <br />Rate <br />■ <br />GPH <br />LINE <br />■ <br />Tight <br />or Fail <br />Exist <br />LD(s) <br />Pass/ <br />Fail/ <br />or <br />NONE <br />NEW <br />LD(s) <br />Tested <br />& <br />PASS <br />TANKS and LINES Tested to CFR -40 Parts <br />280 281 & NFPA 329 Specs. <br />Other: <br />,,\,�j�.�✓ <br />W} 1J IG <br />l <br />DI meter <br />Material <br />C7 r1 <br />3 <br />C <br />t <br />Exist LO SN/AtOL/MFG'. <br />Nev, LD SN/MDL/MFG.. <br />LINE TEST PSI <br />Di5pM5M Shear Valves <br />O ate es/no <br />Percent of FIII at Pump ,.-._ <br />Start Time: Time of Test: Mfg, V r+Li <br />T n st I. - Probe <br />li Ertel Tim.- Entry Point, V—\ LAI <br />ll C <br />1 V t� <br />DJJJaaameter <br />/ } l <br />�Mla�`terial <br />�A <br />V <br />-f <br />N <br />� <br />,( <br />G <br />No <br />Exist LD SN/MDL/MFG: <br />Nev, LD SN MDLm�FG <br />LINE TEST PSI <br />Dispenser Shear Valves <br />O rate es/no <br />1 � <br />Percent et FIII at Pump <br />Slart Time: Time of Test: O Mfg. (�% �N tC <br />!],� and PS' Probe _ `,,�� l G'\ <br />�J JJ <br />U <br />Material <br />ri <br />�{\ <br />Start Tl me: <br />%Diameter 'lam <br />ll <br />x 1 <br />AU I <br />Percent of FIII at <br />Time of TesC <br />Pump �GlJ�� <br />Mfg. _ e <br />`fC <br />1Q <br />F_P p <br />`']� <br />r C� <br />' �Q <br />5SJ <br />c <br />.J <br />�2 � <br />J <br />z Q\,Q <br />�w i Q <br />l�ji <br />\ <br />\ <br />0 - o c <br />o . o0 <br />•tj� <br />T- <br />j <br />N <br />�.p <br />Exist LD SN/MOLRAFG: <br />New LD SN/MDL/MFG' <br />LINE TEST PSI <br />Disposer sneer valves <br />O rate es/no <br />` <br />l Li� <br />y <br />1_vt A <br />!d <br />Tank r� Probe 1,.1. -- 2 , i� <br />TI Test PSI::1 <br />DemeterF-1 <br />(rII <br />p » <br />F& <br />S� <br />ry� <br />'J9- <br />0- <br />T <br />0 <br />� p <br />Exist LO SN/MDL/MFGLk : <br />New LD SNrMOL/MFG. <br />LINE TEST PSI <br />Dispenser Shear Valves <br />O rate) es/noExist <br />` <br />1 <br />t A <br />`1,2 <br />� �\9 �5 <br />Material <br />Percent Fill at Pump 4,C <br />Start Time:Timet: O Mf U'>r p J J <br />WK — i Probe 't"—; `t_ x ✓J L+^_ <br />Diameter <br />LD SWMDL/MFG'New <br />LDSN/MDVMFG: <br />LINE TEST PSI: <br />Meterlal <br />ill al Pump <br />Stan Time: tMi -. <br />elst PSI: <br />Probe <br />Frit- Priin <br />Diameter <br />Dispenser Shear Valves <br />Operate /no <br />Exist LD SN,MDUMFG: <br />New LD SN/MDL/MFG: <br />LINE TEST PS: <br />Dispenser sneer valves <br />O ate es/no <br />MelBflal <br />Percenteof T0f Fest: N" , ill at Pump <br />Start Tlme: Tlm <br />rank— probeTest PSI. Frit, Pnirit- <br />TANKNOLOGY Region G1I� <br />9� � Unit # � State Lic. # State: GO - <br />:NOTE: Original VacuTect Data recordings are reviewed by Tanknology's Audit Control Department and maintained on file. <br />TAK-01 <br />Tanknology Corporation International <br />5225 Hollister St., Houston, TX 77040 <br />(400) 888-8563 9 FAX (713) 690-2255 <br />