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WORKSHEET FOR SUBMITTAL TO GOVERNMENTAL AGENCY <br /> OWNER/OPFRAT00. �'C.G':'L .'�-1'C. C.•� .,/C:Zc..Ci` Jam=\ y SITE ADDRESS_ ��/-�.y 4: �j JjCf�T-/Z��s z7= <br /> CITY �Tr<��:'� <br /> 2i COUNTY <br /> MAILING ADDRESS <br /> --- —sTTE_xCENT - J �I>'iC-�� �I`L.:�� -�! TELEPHONE EFL <br /> ARRIVED TEST SITLr� OURS TAANNK LOCATION 3fC,J - PRODUCT— <br /> DATE/TIME STORAGE FILLED / L / PRODUCT LEVEL. AT ARRIVAL .0 INCHES BELOW TOP OF FILL NOMINAL TANK SIZE <br /> TANK MATERIAL'' //..�L ,, ,L, APPROX. TANK AGL�G11TRS. FILLSIZE/TTPE�OPEAFILL CONTAIlB1/PNTp TCTPE�JL <br /> API GRAVITY W+�A7 DEC. F. - API GRAVITY OLJZ• `I P 6OF - COEFFICIENT OF EXPANSION OF .000 !7 L COE <br /> VISABLE VENTING APPRIARS TO BE AT: FILL Elm, ILL OPOSITE ENDS . _BURP TUBE, HAS BALL CHECK, UNKNOWN, OTHER <br /> VISABLE VAPOR TRAPS TO BE BLED: BALL CHECKS, MANWAYS, RETURN LINES, OTHER <br /> PRASE II VAPOR RECOVERY SYSTEM: ALANCPD. ASPIRATOR ASSISTED, LONG RUN WELLS, MANIFOLDED, MORE, OTHER <br /> PUMP INC SYSTEM: SUCTION TURBINE MAKE�`J�C..�+�- T� MOD�7?p PIPE LINE LEAK DeteCtOie YES, NO ROT APPLIC <br /> CMIARTID SIZE FST. LINE QUANTITY/2--PRODUCT ADDED 10 FLOOD SYS <br /> TEM_Y-STSTEM TONAL GALLONAGE._�OC�CJ <br /> AMBIENT CONDITIONS: TEMP: PRETES7±6�POSTEST SUNNY, CLOUDY, RAINING, WINDY, BREEZY, NICHT, OTHER ,���G 7 <br /> .4 PSI DRQP'wHOURS TEST 70 START 4-:04 -iI0UR5 PSI TO BE MAINTAINED ON TANK BOTTOM DURING TEST PERIOD S p S I <br /> A. GRADE TO TANK ROTTOM 1J j <br /> O ZS B. GRADE TO TANK TOP 194 <br /> C. TANK DIAVETER <br /> 6.Pi20E <br /> -~ D. TEST LEVEL ABOVE GRADS Za <br /> E. RKiTOM.LL eROINO RATER ATANK <br /> GO .036 T <br /> FILL TO PROD. AT AAVAL <br /> F. TO - <br /> //� <br /> ALS/ G. TOP OF FILL TO TOP OF TANK <br /> y x. TEVT:U='.TUIOMTO" OF TANK <br /> Cy <br /> NATER IN 7 PSI PER INCH OF ►YDVOCT L <br /> E TANK ... w / TEST NET= PRESSURE FORMULA <br /> REMARKS: x. NET rst E. rs1 NET rs1 <br /> RESULTS <br /> 0OSHE FINAL TEST PERIOD AS SHOWN ON THE ATTACHED COMPUTER GENERATED DATA REFLECTS A <br /> / GAIN OF:I.C' GALLONS PER HOUR, WITH A 99X CONFIDENCE LEVEL OF +/— 47U/ gph, <br /> TFOR EE HORNER EZY CREK II OD COMPLIES WITH EPA AND THE STATE OF CALIFORNIA PERFORNANCE STANDARD OF 0.05 GPA <br /> 5804RAA80V ET£C T') TEDESHG• (SINDICATECTION 6 AN UNAUTHORIZED RELEASECALIFORNIA CODE OF 8SQUAT, TO ORASED GREATERN THIS TEAS THE RESULT STANDARD. <br /> 1 INTEGRITY TANK RTESTING 44EQVVICES, P.O.BOX 6913T6 STOCKTON, CALIFORNIA, 95269 (209) 4T4-1375 or ($00) 62-8378 <br /> CERTIFIED TESTER , A IIG��' � ) X71 <br /> STATE LIC8898 F i �vj` TEST DATE <br />