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WORKSHEET FOR SUBMITTAL TO GOVERNMENTAL AGENCY (TAKE LAYOUT ON REVERSE SIDE) <br /> �. <br /> rzr.::K: F/I T/� PDP.!5jr .--:G :AN:: LCG:.::Oi' •-`moi•✓ �/i - //�I^'->— i�i_,p <br /> LPJ,EI! / / �• <br /> SAEI LOL--== PRODUCT <br /> LTorTr Lrrr_ CILZERATIONS AMBIENT TEMP. PRETEST 7O POSTEST!L <br /> rzzzzs: POSTEs: Tor Or r= To In or — <br /> LENEs Xy '?j yZ, __ /SOr Oi T= SO TO? O7 SANE WATER PRESENT PRETEST 'M POSTEST_ <br /> n <br /> O7 J-02 INCHES INCHES ABOVE GRADE B TEST START T <br /> SAR D:AMrSI[ , <br /> MDCEIO:i^!.<O to .Lrq _ SEMPLRATDIE CLIIERL�2011s <br /> J AVERAGE L.T.I. none- cRAc-:r �'�. / e G 6 r - oRAc TT or:= <br /> 1 r <br /> o Zs _ So 00 o S O� 44�/t L ZOoo 44 <br /> QLA2.::= ADDED :.IN's HOVEMEN: LIQCZD GONS:AN: (A) COErr;.'iLK: OF =p ON :AR: :1.°A.'.:T •:LL'PEEL-OR£ roxs:AS: (E) <br /> /¢Z ' ,rKVEL LEVEL GAIN+ TIMES T,rPrj 'EMP. TEMP. GAIN+ TIMES TEMP. FIP.1L <br /> TIME E=AP. T END LOSS- CON A �"-StiLT START END LOSS- CON B - RESULT RESULTS <br /> 440 6 .44f If:OO&Y <br /> - o�i9S <br /> 1 -.,00zY <br /> SL s� I 1 —5/ / 1—,002- 1 .4001 ,40i I � voj ( I �u0p45 ,00z¢5 -yo94 <br /> i�4� ISS I53 I -ZI ) I oG 4Di I , 4ozI / I .�u7�s o�/4s <br /> e�ss I s3 15� I - z I � I -•oo, soz 1,403 I -�.ov/ I .ods ' .�/gs <br /> .403 4;oo I I x,00045 <br /> 4t2l 1. 'lo" - 1f.00/ 1 .449 14-,�5 - ooz45 <br /> o' oD THE I'INAL-EDUR OF po73 <br /> DWNLR/OPERATOR /�/ATv '�-�/U Sa'��'�. � TES'_'TNG P.EFLECTS �a.CSr L._F OF: " <br /> SITE ADDRESS ✓ T C _HAILING ADDRESS ADDRESS RNEE LST CHEL METHOD OF PRECISION TESTING THE RESULTS <br /> CITYST'a GH--/'bti ��T-QS apr �,•�Ta,F{, ARL RCT ['_rEXr TRE STATE OF CALIFORNIA AND THE NFPA <br /> 329 CL`IDELZN _ O55 OF .05 GALLONS PER. ONE HOUR. OF <br /> COOK" - .GFt (.�JC�/!/.LCi�— // TESTING FOR A TICE: :ART./SIE'EY.� <br /> TELEPHONE (G� ) QG — Z�/ G INTEGRITY TANK TEST (E <br /> TTS-.INC ST STEPS, INC, 1FRAME NEST CIRC1E <br /> /ter STOCKTON. CA. 95206 (209) 6-6036 (800) 262-8378 <br /> AGENT /y Ls-�%�i""`✓�7�. - r,. G(/ I�' 2 TES: DASE / •-i/? <br /> CERTIFIED ,E..EF. <br />