Laserfiche WebLink
C. WORKSHEET FOR SUBMITTAL TO GOVERNMENTAL AGENCY <br /> OWNER/OPF]U70 _ o y' y �D�/�KJjO'�J�� 527E ADDRESS <br /> Cin T"J9G COUNTY JAXX <br /> NAILING ADDRESS <br /> SITE AGENT �/7� .EJ �� TELEPHONE 4-�/�) –e--��/W 7 <br /> ARRIVED TEST SIYQ TANK LOCATION PRODUCT /G/ �p�<�� <br /> DOSE/TINE STORAGE F,ILLETY-/�/ PRODUCT LEVEL AT ARRI7AL�INCRFS BELOW TOP OF FILL NOMINAL TANK SIZE 14� j <br /> YANK MATERIAL G�CGfi ' APPROX. TANK AGg QZTRS.. F�ILLSIZE/TTPE — EU`ILL CONTAINMEEpNT TYPE / A7�-�,_, <br /> API CRAVLTTJp AT DEC. F. APT GRAVITY OFJT / @ 60F COEFFICIENT OF MANSION OF .000.+''7_5' COE 7� _7 <br /> VISABLE VENTING APPRPARS TO BE AT: FILL END, FILL OPOSITE END, RAS BURP TUBE, RAS BALL CHECK T <br /> (9N�A70WfF%'�nTHER <br /> VISABLE VAPOR TRAPS TO BE SLED: BALL CHECKS, MANWAYS, RETURN LINES, OTHER <br /> PHASE II VAPOR RECOVERY SYSTEM: BALANCED, ASPIRATOR ASSISTED, LONG RUN WH,7.L5, MANIFOLDED, HONE, 17IIJt <br /> PUMPING SYSTEM: CTIOCN THJRHSNL MAKE Tl/.Ca'�Q��I MODEL�IPE LINE LEAK DeteCtOKe YES, //NOT APPLIC <br /> CHARTED 522E Z / FST. LIRE�09ANTIT73 PRODUCT ADDED T9 FLOOD 575TEMLLSYSTEHI TORAL GALLONAGE �{G' <br /> AMBIENT CONDITIONS: TEMPI TII—s PREILST C/C-J�p�p�STLSY/% �DY ENING, WINDY, BREEZY, NIGHT, OTHER y p <br /> .4 Psi 499E4e- HOURS TEST TO STMZ%6 HOURS PSI To BE MAINTAINED ON TANK BOTTOM DURING TEST PERIOD ✓1 Lf <br /> PSI <br /> A. GRADE TO TAM BOTTOM <br /> O� E. GRADE TO TANK TOP G6 <br /> :Er/ <br /> C. TANK DIAMETER70. TEST LEVEL ABOVE GRDEE. E�Ea CYOUND MAY RYABOOVEIT NK` P. TOP OF FILL TD PAOO. AT ARRIvAL <br /> C. TOP OP FILL TO TOP OF TANK <br /> H. TKST:1l MITCIOT'10H OP TANK PSI PER INCH OP ►BOm= �— <br /> TEST HEIGHT PRESSURE POND A <br /> /z/y4 I_3L- - 3, zs <br /> REMARKS: H. PSI E. PSI NET PSI <br /> RESULTS <br /> E FINAL TEST PERIOD AS SHOWN ON THE ATTACHED COMPUTER GENERATED DATA REFLECTS A <br /> (IL(ILO/ GAIN OF:<�ALLONS PER HOUR, WITH A 99X CONFIDENCE LEVEL OF +/- -c2Z2 gph, <br /> THE HORNER EZY CHEK II METHOD COMPLIES MTH EPA AND THE STATE OF CALIFORNIA PERFORMANCE STANDARD OF 0.05 GPH <br /> FOR TANK INTEG ON 2643 CALIFORNIA COAD OF REGULATIONS)BASED UPON THIS STANDARD THE RESULTS <br /> SHOWN ABOVE DOES NOT RJDICATE AN UNAUTHORIZED RELEASE EQUAL TO OR GREATER THAN THE 0.05 GPH STANDARD <br /> INTEGRITY TANK TESTING DIV. OF OIL EQUIPMENT SERVICE, P.O.BOX 950, SAN ANDREAS,CALIFORNIA, 95249 (209) 54 1808 <br /> CERTIFIED TESTER o�� LICENSE# 'PD�rlZ3 DATE /Z <br />