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14. 7 _ i%��,'`C ;=`1✓1 r4o _ LQ L 'L? -.I%. l Name of Supplier, Owner or Dealer 15. TANK TO TEST Ideal by pultbn BtMtl and Oreu Address No. and Street (a) 15a. BRIEF DIAGRAM OF TANK FIELD 17. FILL -UP FOR TEST adgk wirer taotlpn T L�J beloreFllWp In. - in. Int .- Gel Tank Diameter City 16. CAPACITY Slate Nominal Capacity -_,_, ---- Gallons capacity moss accurate - ' <� pacity mart available 18. SPECIAL CONDITIONS AND PROCEDURES TO TEST THIS TANK ❑ Water In tank Linals) being tested with LVLLT See manwl esp applicable, Check below and record procedure in log (27). ❑ High water table In tank excavation Use maximum alwwadetest pmwrefor all tests . 19. TANK MEASUREMENTS FOR Four pound rue due Trot apply a douClewalled tanks. . TSTT ASSEMBLY Complete Oclion below, Bottom of tank to grade' QCT/ Add as,' tor' T' probe may T Is four pound rule requlred7 yes [:]No �J Total tubing to assemble approximate -_.1 w ___ in 2, height to Ir mark from bottom of tank 3. Prsesure r bottom of tank l Pressurer rop olWk i of burial diff. table _ NOTES: The above calculation are to be wed for dry soil conditions to establish a positive pressure advantage, or when wing the four Pound rue W Canpmeste for Rr presence of subsurface water In the tank Peter to KRUPA 3Q SOCHons 2-52.4 and 2-7.2 end the tank manufacturer regarding allowable system test pressures. in P.S.I PSI 20. EXTENSION HOSE SETTING Tank top to grade'..,... .. Extend hose on suction tube a" or more below.tank top ....... .......... tin Fill pipe extends above grade. use lop of fill jJ--_,__-in. _..-" _-_ -. in. Total quantity Ih 22. Thermal -Sensor reading after circulation AyVy - to/+- `L 21. VAPOR RECOVERY SYSTEM digits ❑Sege 11 =F After Circulation ... ..... .. -LJ� •F Between /-y/�' 23. Digits per °F in range of expected change / Z- -dig Difference f•/i ... _. ...., .......-` Belme Reading ts ��•- - COEFFICIENT OF EXPANSION (Camp lete afterlcirculation) TIME Ra NJ 24a. Corrected A,P.L Gravity _in Observed A.P.I. Gravity. .. ...................... Total quantity in Reciprocal Volume charpeM .. Rydrometer employed,.,._ ............................. __--H Observed sample Temperature ....., __._ _. -_.. °F Corrected A.P.I. Gravity @6o°F. From Table A .................................... Coefficient of Expansion. for Involved Product �o From Table 8 .......... ... ..... . . _.. _. Transfer COE to Line 251,. Date of Test From/ L�`'Sletbn Chart L(� Tank Manufacturers Chart ❑ Company En,lnearinp Data Charts supplied with ❑ Other Total Gallons Gallons, as,. Reading 9�0 24b. COEFFICIENT OF EXPANSION Tlanaler total to line 2$a RECIPROCAL METHOD Total quantity Ih - AyVy - to/+- `L 21. VAPOR RECOVERY SYSTEM ❑gager ❑Sege 11 24b. COEFFICIENT OF EXPANSION \�- RECIPROCAL METHOD Total quantity Ih Type m AyVy - to/+- `L .full tank 06 or 17) 2s. taL� Involved product 31 Z Hydrometer Emoioreb _..,.. ......., F' H Temperature In Tank _ -92 Tne e After Circulation ... ..... .. -LJ� •F VNum - /-y/�' Temperature of Gamble .... ....... •F 1•F Difference f•/i ... _. ...., .......-` Belme Reading Alter Readmq ��•- - Obearved A,P. I. Gravity .... ....... TIME Ra NJ Reciprocal _7 �00©D 5�� 7F34/ Total quantity in Reciprocal Volume charpeM fun tank (16 or 17) this tank Per •F _... Transfer for Lkte gess. 24c. FOR TESTING WITH WATER see Table CAD Water Temperature shot Circulation Table.................................. ... .......... 'F Coefficient of Water TableD ._,......,..... ........... .................... Added Surfactant? ❑Yes ❑ Nc Tnnefer COE to Line 251. 25. '- x \�- 31. VOLUME MEASUREMENTS IV) RECORD TO .rpt GAL. Total quantity Ih --= Coefficient of expansion for "-- gallons Volume change in this lank .full tank 06 or 17) 2s. taL� Involved product 31 Z �) per °F a O )O 0 9 X70 standpipe Level In Inches - - _ -92 Tne e VMua,e ehen,rle F(25o 2M1 Din. �•F Yn:nvi VNum - Temperature Adjustment nengsj237 Compute to a declared placl eCmr 1pj 27• 1,111111 OF TEST PROCEDURES ' (SUPPIOW~ 30.. HYDROSTATIC PRESSURE CONTROL 31. VOLUME MEASUREMENTS IV) RECORD TO .rpt GAL. 34, TEMPERATURE COMPENSATION USE FACTOR lel 38. NET VOLUME CHANGING EACH READING 39. ACCUMULATE CHANGE 28• DATE Rerord details of setting up and running test. Use full - P ( length of line It needed) 29. Reading No standpipe Level In Inches 32, Product in Graduate 33, Proeud Replaced I -I 35, Thermal Sensor Reading 36, Change Hignar • Lower - Ic) 37. - Computation (c) - (a) . Expansion • Contraction- Temperature Adjustment At Low Level sore" Galanga pr MOW (NWA unerle) Beginning pl - Reading Level to which Restored Belme Reading Alter Readmq Product Recovered l•) volume Minus Expansion pl or Contraction l-) e331V)-e37(T) TIME Ra NJ 2.410 �o _ 2/ 20 �,� �< v ------- --_ :�/o2-135 -- acv / 20 - j(v S00 sly a�,' �, v s" ---- 71 030 0 T y -- ---- 38 f 7- -, 12-1 S 3s� (,Or- . 531) 3A, -- I 4- It/7 222v � -,/32- 2235 ---- T�� Ch t67 - 4-3 Z3so 4- )G3I -, Or, ( 3.2 .530 .690 1 'v4o X20 .} � 1 . �$ -.OZ P -T Tank Test Data Chart Additional Info - -0/7 1. Net Volume Change at Con ! a�on of Precl Te"cst�yTgph Signatureof Teeter: CC ;' � Date: PN6es2g 1 Tank ent and 11 Tank and product handling system has been tested tight accorping to the Precision Test Criteria as established by N.F,P.A. publication 329. This is not intended to indicate permission of a leak. OR ❑ Tank and product handling system has tailed the tank tightness test according to the Precision Test Criteria as established by N.F.P.A. publication. 329. It is the responsibility of the owner and/or operator of this system to immediately advise state and local authorities of any implied hazard and the possibility of any reportable pollution t0 the environment as a result of the indicated failure of this System . Heath Consultants Incorporated does not a9aume any responsibility of liability for any loss of product to the environment. Tank Owner/Operator � Date .. __..-1--i