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Data Chart for Tank System Tightness Test <br /> PLEASE PRINT <br /> 1. OWNER wgpern❑ ✓ r C .� <br /> Nems V Addrr Rapmantative Tel.ardnt, <br /> Tenklsl El <br /> Nems Adds Reomanntive Telephone <br /> 2. OPERATOR Noma AOe,e„ Telspnnne <br /> 3. REASON FOR <br /> TEST _ <br /> (Explain Fully) <br /> 4. WHO REQUESTED TdW Compam'or AHlliatbn Da's <br /> TEST AND WHEN "°n" <br /> Addrr Telephoas <br /> Identify by Dlnaoon Capedty enndBupplier. P..* <br /> Approx.Ape Stee. iberplr <br /> 5. TANKINVOLVED G3J f Otl % f <br /> d 60 / v ,e <br /> W additanal linea .p / • r <br /> for manifolded tanks •i I <br /> Loceti n Cover Rita Sipnonae Pumps <br /> 6. INSTALLATION �l1 y�� N!/� <br /> DATA �, � tt�3 / <br /> North inside ddvetaay, Cgnersta Blah Top, Size,liteBll make.Drop Suctwp,RamoN, <br /> Rev of atetlon,atc. Earth,atc tubm,Remote FlIIs 9zs.Maniblded Wniclf tanks? Make H 4nown <br /> 7. UNDERGROUND le the taster over the tank? <br /> WATER Depth to the Water table ❑yes 11 No <br /> 6. FILL-UP Tanks to be hued hr. Data Arranged by Rams Telephone <br /> ARRANGEMENTS Extra product b'Top off'and run tank tsetse. bw east wM to p ovidaT Consider NO Lead. <br /> Tarminel or other contact <br /> for notice or Inquiry Company Name Telephone <br /> 9. CONTRACTOR, <br /> MECHANICS, <br /> any other contactor _-- <br /> nvolved <br /> 10. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> Atldiponal Inlomution on any items above.ORiuela or pram fo De advised when tatting Is In praprex er complated.Helton or obserron present dunnp teal,stc. <br /> Tests were made on the above tank systems In a rdenca'wtth teal procedures prescribed for <br /> 11. TEST RESULTS as detailed on attached teat charts with results se follows: <br /> Tank Idemiticatlon Ppn, Leakage Indicated osta Tested <br /> fit r <br /> 14 <br /> — tae — Y <br /> 12. SENSOR 13.This is to ceytty that these,tank systema war.'"Led on the dated)sho"m.Tthoaa Indicated as Ttphr mod la la licrhw "t"blished by to <br /> CERTIFICATION NbOn l Flat pO~coon Aesocia don Pemphlat 4 <br /> 32 <br /> tt T.cnnloisna �� /l"��� <br /> Del. <br /> TwfNq Corhtracter er CComaerw. my awpurs <br /> 6Nn,W .I Thermal c.nmo.11un. s va r3�c k�, Cara <br /> Sensor Adder <br /> h g <br /> Caridlnatte,0 \s. ON6627 <br />