Laserfiche WebLink
Data Chart for Tank System Tightness Test <br /> PLEASE PRINT <br /> 1. OWNER Property❑ ' <br /> Nam. sr Representative Telephone <br /> Tenko)1_I <br /> Nash adorer Pepmentalir Tlepnon• <br /> 2. OPERATOR Nems Address Telephone <br /> 3. REASON FOR <br /> TEST <br /> IEaplaln fully) <br /> 4. WHO REOUESTED <br /> TEST AND WHEN Nam Title company orAelharon Data <br /> Address Teephons <br /> Identity by Direction capac,ry Brand/Supplier Grade Approx.Age St"Aienglar <br /> 5. TANK INVOLVED <br /> IC kJS <br /> Lee additional lines <br /> for manllold•d tanks <br /> Location Gear r !a Vents Sipho. Pumps <br /> 6. INSTALLATION � 2 i ( yo 4,)/r, <br /> /, a <br /> DATA 6J ftwitz <br /> Fnit maids drive .way, Concrete,Berk T.Q.Too. Sae.Tltetw make.Drop &MoRrenote. <br /> eer of stetson,etc Earth,etc tube,Pemots Fill. Sze,Manitotoed which tenks? Make if known <br /> 7. UNDERGROUND Is the wrier over the tanks <br /> WATER Depth to the water table ❑yea ❑No <br /> 8. FILL-UP Tanks to be lined hr. Date Arranged by Name Telephone <br /> ARRANGEMENTS Extra product to sop ofr'and run tank toter. Fiow and who to provide? Consider NO Lead. <br /> Tarmints or other contact <br /> :ar nodes or incuiry <br /> Company Name Tw pnone <br /> 9. CONTRACTOR, <br /> MECHANICS, <br /> any all contractor <br /> involved <br /> 10. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> Additional iniornrahinn on any narra above.Cxicela ur clhen m ce advised when xsEng I.m p¢gmae or completed.Vifdoo or obaerve0 praeent dunnp tort.etc. <br /> Tests wen made on the above tank hyetsme in accordant with teat procedures prescribed for <br /> •11. TEST RESULTS es detailed on atlacMd test chard with results as follows: <br /> Tank ldentlncatior IgM Laakage:cd¢a:ed Date Tasted <br /> I <br /> 12. SENSOR 13.This,Is to*belly"het the.tank systems,wen,tested on the dell(.)shown.Theses Indicated as-ng ht's meet the criteria established try the <br /> CERTIFICATION National Flo P1OaG1on Association pamphiet 3M <br /> r«nmduw ` <br /> Date <br /> t � <br /> 4Calif& C&U-1 <br /> /[J n �a �, irtlnp can<�nwct{p"a Cgmpeny. iN:'Sign <br /> e <br /> Serial No ul Thermal Canftxlon. ' `/ T �— T Py (,�ly.-� � �}(�'(�,. Ve a s ] t1 V if <br /> s.n.p. <br /> Address <br /> CenMcation 0 PNPe27 <br />