Laserfiche WebLink
Data C' -r for Tank System Tigth' 's Testi �l �l1a44u <br /> peNeed, tro Titer OCT 2r; 9R7 g <br /> PLEASE PRINT TANK TESTER <br /> 1. OWNER Property ® _ <br /> I <br /> .PrePnl.trn <br /> Tank(s) <br /> Name Aedq.. bor .onUora Lbphon. <br /> 2. OPERATOR L c 15'1`0 0 <br /> 0 <br /> N... Add.... <br /> 3. REASON FOR <br /> TEST <br /> ([.plain Fully) .. <br /> i <br /> 4. WHO REQUESTED <br /> TEST AND WHEN M Common,is, ilNllon Oat. <br /> Admey Telephone <br /> 5. WHO IS PAYING A1081-0 CAL <br /> FOR THIS TEST? Comp.ny.Aeendy or Individual Pelson qulhOdilnp Title TalaDhone <br /> Benno Addms City Suite Zip <br /> Atrenhon of: Order No. Othn l.w.coon. <br /> Idyntiiy by Direction Capacity _-- -- -Brand/Supplier____ —Tirade_- __ _.J,pproa.Ape- ... ._Steel7Fiberglass <br /> 6. TANK(S) INVOLVED # I � S <br /> 2 G .4 i <br /> S .,L <br /> Location t Cover Fills Vents Siphons Pumps <br /> 7. INSTALLATIONfi5rdc CDIICRG 1�' 2�y -v ^tf n� <br /> DATA 0( ASP►1T�� <br /> Non Inside d,vsway. Cenoete.pock Too. Sire.Tkelin make.Drop Suction,PemoN. <br /> Rear of inside <br /> di .tc. Ean.etc. re- ..Ramon FIII. 1...1.01.111 Which a nks 7 Make if known <br /> 8. UNDERGROUND Is the water over the tank If <br /> WATER Depth to the Water table.RS40 Lw/ LANA /3frrCd4­ E] Yes 0 No <br /> Tanks to be fined bY00 h,. .16 oar Date Arranged by d/tKf COR-002A 17118- a PG 6 <br /> 9. FILL-UP Nam• TNeonone <br /> ARRANGEMENTS Extra product to"top off'and run TSTT. How and who to provide 7 Consider NO Lead. <br /> Terminal or other contact - <br /> for notice or inquiry <br /> ComwnY N.me Tdeohone <br /> 10. CONTRACTOR, <br /> MECHANICS, <br /> any other contractor 3 <br /> involved �[ <br /> 11. OTHER , <br /> INFORMATION <br /> OR REMARKS <br /> Additional information on any items above.Officials or others to be advised when testing is in progress or completed Visitors or observers gasem <br /> during test etc. <br /> Teals wan made on the above tank systems In accordance with Lest procedures prescribed for V!d TfiP <br /> 12. TEST RESULTS as detailed on attached last charts with result•es follows: 'c <br /> Tank Identification Tight Leakage Indicated Dote Tatted <br /> cS IOIY - <br /> tt 2. I — •C31 0-0 <br /> it 3 h Ej t o Z-7- <br /> This <br /> LTMs Is to t»rtity that three tank systems were tasted on the dNe(s)shown Those Indiuud to•Tight' t IM girls established by <br /> 13. CERTIFICATION the National Fire Protection AaoclMlon Pamphlet 112x. - <br /> 7/zg /B <br /> NCQ <br /> moi, �11 Tro>� I I nIcn t y. ronnwe r <br /> 5 0 ! z Ste_ �-)G✓� }{t C �( Post 0( e box 588 <br /> brae Nv at lTermal .ahnkun. atucklon,LA 95201 sdnn <br /> hrery <br />