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ENTAL <br /> ''NC <br /> Data Chart for Tank System Tightness Test <br /> PLEASE PRINT <br /> 1. OWNER Prower (rJ r y�if>Em� sew c.L .Dlst. 1. ',�t. F�v1lL, S>�,tfW <br /> p� Nam. Address Representative Teophona <br /> Tank(&) .® <br /> Nsmv AddrW ,We like <br /> TNepnoM <br /> 2. OPERATOR --ire-Z � <br /> Na rewnone <br /> 3. REASON FOR <br /> TEST <br /> (Explain Fully) <br /> 4. WHO REQUESTED � '� / oedv�e• �! /mr �medf�� <<,� �L IJist !-Si6s <br /> TEST AND WHEN Nem. Ties comwnv of ANdwwn Dase <br /> _/F �!/. r'! i!✓MG .DL. S'T,is �w �wV• 2n9- 9� for-yn/6 <br /> Address Telephoto j <br /> 5. WHO IS PAYING Stet.,• /www/fc/ sc•I�iPL .Zbs>_ <br /> Company.Ag army or In irni ual P.M.zoinumiam, ties T~..FOR THIS TESTI _/;F Al— �4_i / DQ sr� � CN• 3.r=o?' £s/ <br /> Billing Address City Sure zip <br /> r F�� <br /> Attention of: Order No, Other Instructions <br /> Identify by Direction Capacity Brand/Supplier Grade Approx.Age Stesl/Fibeglass <br /> 6. TANK(S) INVOLVED A0Zeloo rG <br /> / s., STBCl. <br /> Location Cover Fills Vents Siphons Pumps <br /> 7. INSTALLATION Snc,f4 xyF �qa?! `/' /v.;me- <br /> DATA sc s i.-i- Z " <br /> Not <br /> Noun Inside driveway, Connate,slaps Top. Size.Titehil <br /> Remese,prop Suction.Ramose. <br /> Resr of station.,etc. Earth.etc, too.. mote Filre Sue,Menllolded Which renkr) 1Maa It Ynown <br /> 8. UNDERGROUND Is the water over the tank? <br /> WATER Depth to the Water table Z- ❑ Yes R'No <br /> Tanks to be filled hr. Data Arranged by <br /> 9. FILLUPN.m. Telepnon. <br /> ARRANGEMENTS Extra product to"top off"and run TSTT. How and who to provide? Consider NO Lead. <br /> Terminal or other contact <br /> for notice or inquiry <br /> Company Name Telephone <br /> 10. CONTRACTOR, <br /> MECHANICS, <br /> any other contractor <br /> involved <br /> 11. OTHER %y" �cVdU,t de/[FN ALS s s�t�F O� T/pjlf/�S <br /> INFORMATION k n <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 present <br /> during test etc. <br /> Tests were made on the above tank systems in accordanp with Best procedures prescribed [or PplrO TItP <br /> 12. TEST RESULTS as detailed on attached lest charts with resufts as follows: <br /> Tank Identification Tight Leakage Indicated Date Tested <br /> This is to certify that these tank systems were tested on the date(s)shown.Those indicated as"Tight"most the criteria established by <br /> 13. CERTIFICATION the National Fire Protection Asoetation Pamphlet 329. <br /> C � <br /> -�L-o.f— 1/C/ po.✓ Testing CpnfrartorrrCompany )f ay f.-f/a-1--:-.,-,,::- <br /> ENVIRONMENTAL LABOP.ATOR;CS, 11JC T — <br /> s.nat No m rno,mai Technicians 1447 E.Shaw Ave. Suite 150 Fresno. CA 93710 <br /> Sensor (109)115-5698 <br />