Laserfiche WebLink
PLEASE MINT <br />�4i.1 Jb�-Qv.v <br />r 'a Chart for Tank Systle Tightness Test. <br />�-/ 7-56 <br />1. OWNER ►tooerty ❑ <br />Tank (a) ❑ <br />('� �'� <br />Nanta `D R�r F-�`:•f'!Yi 61i1G�-'tr i G / AN • LOI�� _(�� Telephone . <br />�% <br />Narne Address llapreNnlative Telephone <br />2. OPERATOR <br />Name Add,@" Telephone <br />3. REASON FOR <br />TEST <br />(Explain FWty) <br />4. WHO REQUESTED <br />TEST AND WHEN <br />/—, r"" contanyo.Anainion Date <br />Address Telephone <br />5. TANK INVOLVED <br />Use additional lines <br />lormaMolded tanks <br />Identity by Direction Capacity Stand/Sepphar Grade Approx. Age Sl"/Fiberglass <br />6. INSTALLATION <br />DATA <br />Location Cover Fills vents S:ononas Pumps <br />0 <br />tIN <br />North inside driveway. Concrete. Bled Top. Size, Thefill make• pop sect n, nemole. <br />Rear 01 station, etc. Earth, etc tubes, Remote Fills Size. Wniloided Which tanks? Make it known <br />7. UNDERGROUND <br />WATER���" <br />o is the water over the tank' <br />y "o <br />Depth to the Weser labia _ <br />8. FILL UP <br />ARRANGEMENTS <br />'myliy. <br />Tanks to be filled hr. l� L D.I- Arranged by <br />Name - Telephone <br />Extra product to ioP Otr and run tank tester flow and who to provide? Consider NO Lead. <br />Terminal or otner contact �y „� t 'nom r <br />induiry w ��J <br />for notice or <br />Company Lyme Tatephone <br />9. CONTRACTOR, <br />MECHANICS, <br />any other contractor <br />involved <br />.. <br />EA_ 1 '61 <br />Gt47 <br />OCT 4 999 <br />10. OTHER <br />INFORMATION <br />OR REMARKS <br />M'MROMVILN _AL 11-1 <br />mtee, '4c - <br />Additional info—tion on airy items above. OtfWAMb e or others be advised when testkq is in progress Or oomptated. Vls"Orf or observers Wasent dunnq <br />11. TEST RESULTS <br />Tests were made on the above Lank systems In aecordi nce whh test procedures pnocrlbed for <br />as detaLLed on attached test charts with mutts es toaows: <br />Tank Wenn tion T'qM leakage W4kd d Date Testes <br />12. SENSOR <br />CERTIFICATION <br />13. This M b c*rWy that ttheee tank system wort, laded on Ow dato(a) ehot Thoes Y+dIcated as i nheel the «tad. by. W" <br />Na"Ond tar. Prot.ctlorh Aaeociabori Pierno" 321 <br />r"`-1 <br />TectwtieWr"sGina — <br />C (( (� r TeetYq kw or <br />Certification r ^ i�l (- 1 � <br />Date <br />Serial Noerm <br />. o1 Thal <br />lAddress <br />2 <br />Cemtecetlon a <br />Qkl 1 <br />v►aeaa' <br />