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WORKSHER FOR SUBM/I�TTAL TO/G'OVERNMENTALICENCY <br /> SITE ADDRESS <br /> CITY J"Z /�TL'�C� COUNTY <br /> }}l- <br /> l. MAILING ADDRESS <br /> SITE AGENT TG/,-I A[ Lci/J /�✓�=.� �/ ! �TELEPUGHE�("�L) '7`,>n;'J�' ✓-�•j J <br /> ARRIVED TEST 5I (r'HOI/RS TAANIK LOCATION GJi/Y �Gl� ci(/..SL/JL- PRODUCT <br /> DATE/TIME STORAGE FILLED/L-� '+'RRODUCT LEVEL AT ARRSVAI, INCHES BELOW,Tor OF FILL NOMINAL TANK SIZE / G� --<-, <br /> TANK NATQPALG�_f's APPROK. TANK ACL YRS. FILLSI7.E/TYPE �/' OVERFILL CONTAITBIEN7 TTP6�i"-Gam" <br /> MI GRAVITTSI'r% AT6DEC. F. - A��Pi ''G--RA��VITY OF.3� @ 60F - COEFFICIENT OF QPANSION OF ,ODO ��,1 7 - COE <br /> VISABLE VENTING APP0.EARS 7D BE AIR' F�l TILL OPOSITE ERNS, HAS BURP TUBE, HAS BALL CHECK, UNKNORPN, OIHFR <br /> VISABLE VAPOR ISMS 7O BE BLED: BALL CHECKS, MANWAYS, RETURN LINES, OTHER XL-�-6C TC /�� <br /> PHASE II VAPOR RECOVERY SYSTEM: BALANCED/, ASPIRATOR ASSISTED, IANC RON WELLS, MANIFOLDED, PONE—�OTHER <br /> PID��ING SYSTEM: SUCTION TURK IRE MAKE_L C/�r�l%/✓) MODEL 7,Yy PIPE LINE LEAK Detectors IRS, NO p07 MPLIC <br /> CHARTED SIZE C� � EST. LIKE QUANTITY 2-� PRODUCT ADDED TO FLOOD SYSTEM-L=31STEM TORAL GALLONAGE ,C7� / <br /> AMBIENT CONDITIONS: TEMPI PRETEST555 POSTEST_ SUNNY, CLOUDY, INING, WINDY, BREEZY, NIGHT, OTHER [� <br /> .4 PSI DRd�HOURS TEST TO STAIVZ!?:� HOURS PSI TO BE MAINTAINED ON TANK BOTTOM DURING TEST PERIOD �, / TSI <br /> A. GRAPE TO TANK AUHPUM /�712. <br /> O 2— B. GRADE To TANK TOP _ <br /> C. TANK DIABETER �yz <br /> 6G,AE 2z <br /> mD. TEST LEVEL ABOVE CMOSE. [STERNAL CPDOND MATER ABOVBTANK <br /> BDPTMtN. K .0361 PSI - <br /> P. TOP OF FILL M PROD. AT ARRIVAL <br /> C. TOP OF FILL TO TOP OF TARS �N. TLSP-LBFEL'TO R0TIMN OF TANKPSI Pep INCH of PRODUCT TEST HEIGHT PRESSURE FORMICA <br /> S I 6:7/ _ _ <br /> x. PSI Pst MET—Ps <br /> REMARKS: <br /> RESULTS <br /> 11E FINAL TEST PERIOD AS SHOWN ON THE ATTACHED COMPUTER GENERATED DATA REFLECTS A <br /> O / GAIN OF.i,004 GALLONS PER HOUR, WITH A 99% CONFIDENCE LEVEL OF +/- pod Qph. <br /> THE AORNER EZY CH S METHOD COMPLIES WITH EPA AND THE STATE OF CALIFORNIA PERFORMANCE STANDARD OF 0.05 CPH <br /> FOR TANK INTE TY FRYING. (SECTION 2643 CALIFORNIA CODE OF REGULATIONS) BASED UPON THIS STANDARD, THE RESULTS <br /> SHOWN ABOVE: DOES NOT NDICATE AN UNAUTAORIZID RELEASE EQUAL TO OR GREATER THAN THE 0.05 GPA STANDARD. <br /> INTEGRITY TANK TESTING ``SERVICES, 41 WEST YOKUTS ST. STOCKTON, GA., 95207, .y(209) 474-1375 Or (800) ,262-847e <br /> CERTIFIED TESTER �' `L{t'(G �. STATE LICENSE 0 -/�� '�li)/i/ TEST DATE.7 <br />