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Data Chart for Tank System Tightness Test <br /> Rtfro TifP <br /> PLEASE PRINT TANK TESTER <br /> 1. OWNER vrooanr <br /> os %!✓-»%'Y_- <br /> . aar ............ <br /> Tanks) rai.onen. <br /> N.me Address Red,...nl.1W. raiders. <br /> 2. OPERATOR <br /> N. Address Telesne. <br /> 3. REASON FOR '� <br /> TEST <br /> (Explain Fully) <br /> 4. WHO REQUESTED <br /> I —! <br /> TEST AND WHEN "ams Title toms..or wnul.uon Data <br /> Add,.y Taidaaysed, <br /> 5. WHO IS PAYING <br /> FOR THIS TEST? Compa..Agency OF Individual Person Amredtlsa nee Taldlmael <br /> amino Address Cur stab La <br /> Attention ol: Ober No. Other In.recron. <br /> Identify by O'vaction Capacity Brand/Supplier Oode Approx.Aga Sleal/Fiberplaas <br /> 6. TANK(S) INVOLVED rJc7 l <br /> r <br /> loea Cover fills vents $ionones Pdmp1 <br /> 7. INSTALLATION ` <br /> DATA <br /> Neth 9.1. Conoete.aleck Teo. Sea TIWIII mea..Dr.. SUAbn.Rampu <br /> Rur el moon,etc. Eapn,eta mode <br /> Rimer.fills sin.Mmdolded wni<n ten41 Mab 116".n <br /> 6. UNDERGROUND Is In.water over the tank) <br /> WATER Depth to the Water obi. re. 9-b- <br /> 9. <br /> to be filled hr. Data Arranged by <br /> 9. PILEUP rv.m. Tebpnond <br /> ARRANGEMENTS fairs product to-top for and run TSTT. Now and who to provide ir Consider NO Lead. <br /> �7' <br /> Terminal or*the,contact <br /> for notice or Inouin, <br /> Come.nr N.md Taiap.. <br /> 10. CONTRACTOR, <br /> MECHANICS, <br /> any other contractor <br /> Involved <br /> 11. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> Additional information on any iuma above.Official..1 other.to be advised when testing is in progress or completed.Visitors or observers peed Pet <br /> during test Pec. <br /> Tests were made on the above lank systems In accordance with test procedures prescribed forhI} <br /> 12. TEST RESULTS as detailed on allaChod teat charts with results as follows: "112r?T_P <br /> Tank Identification Tight Leakage Indicated Dale Tested <br /> This Is to cerftty that these lank systems were tested on the Metals)shown.Those indicated as"Tight"meet the cntarh established by <br /> 13. CERTIFIC ION <br /> the National Fire Protection Asoclatlon Pamphlet 329. <br /> a 11r� Lawrence Tank Testing <br /> D.. P.O. Box 407 <br /> .. ai <br /> Sma1 Nor Thermal T.cnnrm... Downieville,California 95936 <br /> S (916) 289-3109 <br /> Sanaa (916) <br />