Laserfiche WebLink
Data f' -t for Tank System Tighe ss Test <br /> petro mtP <br /> PLEASE PRINT TANK TESTER ' <br /> 1. OWNER ProperlyC �/ Stu C/je�20FEE �N <br /> ® Name Add.. Representative C T.lephone <br /> Tank(s) X 6&2J <br /> Name Addrera Repm»ntative Tel.pho.a <br /> 2. OPERATOR <br /> No.. Address - TN.p.00. <br /> 3. REASON FOR <br /> TEST q f <br /> (Explain Fully) <br /> 4. WHO REQUESTED <br /> TEST AND WHEN Nam. Tide Company or ANifieum Dna <br /> Sv <br /> Addrors Tel.phona <br /> 5. WHO IS PAYING <br /> FOR THIS TEST? Compeny.Agency or Individual Person Attracting Title Telephone <br /> Billing Address City Sul 21p <br /> Atlantic.of: Order No. Other Imtrracnons <br /> Identify by Direction Capacity Brand/Supplier Grade Approx.Age Stssl/Fiberglass <br /> 6. TANK(S) INVOLVED e14 ill 0 a. ST,fal <br /> lb.L"l /40,00fi F <br /> of <br /> Location Cover Fills Vents Siphones Pumps <br /> �af>< o4 Ccwoaelt 0e, o/-E <br /> 7. INSTALLATION air/ <br /> DATA ��j pC�,/Ap N0 /reo%/e.Fed <br /> North inside dlivaway. Concrete,Black Top. Size.Titelill make,Drop Suction,Remote, <br /> flea of station,els Earth,am. tubes.Remote Fills Size.Manifolded Which finks 7 Maker if known <br /> 8. UNDERGROUND '/ - Is the water over the tank? <br /> a <br /> WATER Depth tothe Wwrtabla /If0 /7'762 ❑ Yes R1 No <br /> Tanks to be filled hr. Date Arranged by <br /> 9. FILLUPName T.I.Ph.m. <br /> ARRANGEMENTS Extra product to"top off"and run TSTT. How and who to provide Consider NO Load. <br /> Terminal or other contact <br /> for notice or inquiry - <br /> Company Nam. TNaphpne <br /> TO. CONTRACTOR, T <br /> MECHANICS. <br /> any other contractor <br /> nvolved <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 present <br /> during test etc. <br /> Tests were made on the above tank systems In scfbrWrtcs with test procedures prescribed for p f ft iLM <br /> 12. TEST RESULTS as detailed on attached test Charts wilt results as follows: Mww— <br /> Tank Identification Tight Leakage Indicated Dew Tasted <br /> This is to certify that these tank systems were tested on the datets)shown.Those indicated as"Tight"mean the criteria established by <br /> 13. CERTIFICATION the Nation protection Asociation Pamphlet 329. / <br /> Daw Taftlnp Cann¢tor or C9mpa.Y. By: Sl9natura <br /> �3y—/62.3J r /f r �, 737 W Go/�rr7A,Q7A� G✓vQ(i <br /> Bared No.N Thermal Techmcume Addrers <br /> Senator ..�_ <br />