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Data Chart for Tank System Tightness Test <br /> petro TrtP <br /> PLEASE PRINT TANK TESTER <br /> 1. OWNER P,do r, - / _. - ' /- ./ [- r!G/gid' <br /> Nam• Aadrv. R.pN.•nww• TN•IY,OM <br /> Tank( <br /> Tat.. Addr. R•n.tNW. T•NMOM <br /> 2. OPERATOR "-/; . � .•� <br /> N.m. AOdrata INapIIOM <br /> 3. REASON FOR <br /> TEST <br /> (Egplelh Fully) - <br /> 4. WHO REOUESTED <br /> TEST AND WHEN trema fi"' Comwny Or AURudon Data <br /> Address TYUMIM. <br /> 5. WHO IS PAYING <br /> FOR THIS TEST? Crunwny.A,...1.1 Individual R.N .Aumorinn. Title TNww• <br /> Billing Address city Suit. 24 <br /> A.0 nno.OI: Ord.,No. other InNruClbM <br /> Identify by Dwwron Capacity Brand/Supplier Glide � � Andros.Ag• Ssel/Fibuquas <br /> 6. TANKS) INVOLVED r" ' 6 o .r'-ire I%i//'�1 <br /> LW/fie <br /> Location Cover Fille Vents Siphortas Pumps <br /> 7. INSTALLATION <br /> DATA <br /> North Intbe ddvew.Y. Con"....Bla.k Too. Sir•.TIINIII m•b.Crag Srower.Aew•le. <br /> b.,OI 11:"...N.. EanO,Na. IudeL R.mot.files Slee.M.MIOIO.d Wn4h lank.? M.ae Y kn•wn <br /> 8. UNDERGROUND I.the war.,w.r the tank? <br /> WATER Depth to the War table — Tee No <br /> Tanks to be filled_he Data Arranged by <br /> 9. FILL-UP wm. Tr.enw. , <br /> ARRANGEMENTS E.118 Woduct to"top oft"and run TSTT. How and who to provide) Con.ido NO Lead. <br /> / rr7' <br /> Terminal or other contact <br /> (w notice Our Inquiry <br /> Coresident, Nam. T.teAeene <br /> 10. CONTRACTOR, J '� <br /> MECHANICS. <br /> anyother contractor <br /> involved <br /> 11. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> Additional information on any lights strove.011lclala or others to be advised when string i. m Drogtew or computed.Vlsnon or Obsarnrs present <br /> during is.,etc. <br /> Tub wars,made on the above lank systems In Accordant•with test proceduna prescribed Tor pr Tale12. TEST RESULTS AA detailed on attached test Chan.wlth results as touowa: <br /> Tank ideninliulion Tight Leakage Indicated Dau Tested <br /> y_ y� <br /> O r / � H <br /> 13. CERTIFICATION This Is to eerily that In...tank system.wet•tested on the d.te(.)shown.Those indicted as"TIgh1"inesl this,viler,egp jaij had by <br /> the National Fur.protection A.oelallpn pamphlet 329. <br /> �l h Lawrence <br /> Tank Testi P.O. Box 407 <br /> new.. <br /> s.nN No.pl Thermal ..hNCpn. Downieville,California 95936 (916) 289-3 09 <br /> s.ltad, <br />