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AT <br />KNOLOG <br />TE CHNOLOGY FOR TANKS <br />qHp THEIR ENVIRONMENT <br />Owner ", <br />Invoice Name/Address f <br />VacuTect`rm TEST REPORT <br />Site Name/Address <br />ys 93 <br />Site # <br />S.O.# <br />Dat � l/ <br />P /co n e <br />/Attn'.�" <br />TANKNOLOGY Region: r` Unit # State Lic. # E State: <br />NOTE: Original VacuTect Data recordings are reviewed by Tanknology's Audit Control Department and maintained on file. <br />TAK-02 <br />5225 Hollister St.. Houston, TX 77040 <br />(800) 888-8563 • FAX (713) 690-2255 <br />LINES <br />Leak Det <br />TANKS <br />Ullage <br />Final <br />Exist <br />TANKS and LINES Te:,ted to CFR -40 Parts <br />280-281 & NFPA 329 SpeC's. <br />See <br />X. <br />Tank <br />Dipped <br />Dipped <br />Probe <br />Water <br />Bubble <br />Air <br />Ingress <br />TANK <br />- <br />Line <br />Line <br />Delivery <br />LINE <br />LINE <br />LINE <br />LD(s) <br />NEW <br />Dia. & <br />Water <br />Product <br />Level <br />Water <br />Level <br />Ingress <br />Detected <br />Ingress <br />Detected <br />Detected <br />■ <br />Material <br />Syst Type <br />TEST <br />TEST <br />Rale <br />■ <br />Tight <br />Pass/ <br />Fail/ <br />LD(s) <br />Tested <br />F <br />Material <br />Level <br />■ <br />■ <br />■ <br />Tight <br />■ <br />■ <br />■ <br />■ <br />■ <br />g <br />Other: <br />Loc:. <br />ST/ <br />FRP/ <br />■ <br />START <br />■ <br />START <br />■ <br />START <br />or <br />ST/ <br />FRP <br />PS/SS/GS <br />START <br />TIME <br />END <br />TIME <br />GPH <br />or <br />Fail <br />or <br />NONE <br />PASS <br />Tank <br />Tank <br />Tank <br />Lined <br />END <br />END <br />END <br />Yes/No <br />Yes/No <br />Yes/No <br />Fail <br />Line u <br />:. <br />E -1 LD sN!ti+DUMFc <br /># <br />Product <br />Capacity <br />i <br />:✓'� <br />� <br />�� <br />Tia-meter <br />New LD SN/MOL/MFG <br />LINE TEST PSI ��� <br />,�L . 1 <br />1 `' <br />1 <br />arena <br />Start Time: <br />Q <br />( <br />rcent o i at <br />Time of Te <br />Pump j <br />Mt (t'1' <br />Dispenser 5near vain <br />o era!e I esmol <br />P <br />.3 <br />Tank,,.,, <br />o e <br />nc i f ometer <br />�� <br />A <br />�t� <br />/ <br />E.rs! LD NMOL/MFG <br />New LD SN!MOL/M1FG <br />iameter <br />n Time: 7 : .� O n ees <br />it/v ��� N `, r 7- S t7 O C I <br />� O ll s <br />) 0 00 U <br />9a <br />UU <br />,�U <br />/ f <br />NE TEST PSI �7' <br />/ <br />Start Time. <br />rcenl 0 ! at <br />Time of Test: <br />/ <br />/ <br />lvlf D fir <br />/� O <br />UU <br />Dispenser Snear valves <br />U erase es/nos <br />atena <br />/qI <br />fl`p <br />End Time: <br />11 q <br />/ 3. <br />/ <br />T st PSI: — /. <br />E obe <br />, / <br />Inclinometer <br />De rees: <br />D SN/MDL/MFG <br />Diameter <br />� <br />s <br />ViVe? <br />. <br />,Vo <br />/N <br />LD SN/MDL/MFG <br />/ln <br />/ <br />5 ^ <br />5 <br />%U <br />D <br />N— <br />TEST PS! S <br />7 <br />rcent O I at <br />Time of Test <br />/_ L7 <br />% �V <br />UTP <br />Mf <br />3` <br />S / <br />5> <br />`y <br />yv (� <br />, <br />LINE <br />/ <br />Depanser Snear vai /� <br />atefla <br />Fn n <br />Start Time <br />an / <br />roe <br />~ <br />nc inometer <br />3 J <br />S T <br />Opera!e I esmol a <br />/y <br />�� <br />EK ILD SN/MDL/MFG <br />New LD SN/MDVMFGercenS <br />Ent Tim �%� T P I'� ` 1 n r ` IT �� C!.� ` a <br />NO r4"i� r F ( J <br />n.I/ <br />�19 <br />7D -,a -meter <br />j <br />( <br />LL <br />Mfmp <br />T <br />S -I <br />5S <br />_LINE <br />4 <br />�7 <br />, <br />TEST PSIarena <br />D,spenser shear varves <br />Start Time: <br />Time of Test: <br />G <br />9 <br />inometer <br />�C� <br />f <br />O erase (yes/no) <br />T P I: "' / r <br />toInc <br />En <br />D r <br />f <br />E a,st LD SN/MDL/MFG - <br />___+ <br />New LO SN/MDL/MFG <br />IameterI <br />LME TEST PSI' <br />Start Time: <br />Percent o at <br />Time of Test: <br />M'rTLP <br />Dispenser Snear valves <br />o erase es/nos <br />arena <br />an <br />Probe <br />Inclinometer <br />E-1 LD SN/MDL/MFG <br />End Time T PSI: En D r <br />ameler <br />New LD SN/MDL/MFG <br />LINE TEST PSL <br />Start Time: <br />PerceTime of Test at <br />MfgP <br />DSuenser 5near v,,-, <br />O zra!e es;nm <br />—at eMr, a <br />End Tim <br />an <br />Test P 1: <br />roe <br />n <br />I <br />I <br />nc inometer <br />D r <br />Tnr,lrnnlnnv <br />r`nrnr:ration international <br />TANKNOLOGY Region: r` Unit # State Lic. # E State: <br />NOTE: Original VacuTect Data recordings are reviewed by Tanknology's Audit Control Department and maintained on file. <br />TAK-02 <br />5225 Hollister St.. Houston, TX 77040 <br />(800) 888-8563 • FAX (713) 690-2255 <br />