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rh <br />ra <br />TELESIS 1450 H;__,,r Blvd., W. Sacramento, CA 95691 <br />Tank Testing (916) 372-7535 <br />AINLAY TANK `TEGRITY TESTER'" FIELD TEST DATA <br />1 <br />TANK <br />NAMEADDRESS PHON <br />Sei�vi �D�L iCG?i/lu°!L (3Q %i[ 5a�fr <br />TEST DATE <br />OPERATOR <br />2 <br />IDENTIFICATION CAPACITY–GALS. MANUFACTURER STEEL FIB RGLS. AGE–YRS. <br />TANKS TO <br />BE TESTED <br />— <br />3 <br />WATERy <br />DISTANCE FROM GRADE TO WATER /D%1 INS. <br />TABLE <br />4 <br />TANK <br />FILL -UP <br />6 <br />TANK WILL BE FILLED !00 (TIME) ON /f–L7 <br />EXTRA 5 GALS PRODUCT AVAILABLE F�ROM� _;; �i r4f liyi/J6 7�71{r E• /' <br />/ <br />FILL UP TO BE ARRANGED BY MR. �7 -wCdep PHONE if/6 I <br />CONTACT AT STORAGE TERMINAL IS MR. PHONE( ) <br />5 <br />NAME ADDRESS PHONE <br />OUTSIDE <br />-- — --- <br />— --- <br />CONTRACTORS <br />6 <br />OFFICIALSS <br />NAME AUTHORITY PHONE M «'6Tpj <br />fEAllAwa '?tSdJp.Pl �rJ d�?��r�2 5 wat S,,,Sen.oi_� r cL___ <br />TO BE <br />CONTACTED <br />SPECIAL <br />NOTES OR <br />J / / <br />OA/e 4v✓r ��"�J�•t% 7EM!/� 5�, <br />PRECAUTIONS <br />6 <br />ALL TESTS WERE PERFORMED IN ACCORDANCE WITH PROCEDURES DESCRIBED IN SOILTEST S <br />INSTRUCTION BOOK. CRITERIA FOR TIGHTNESS IS ESTABLISHED BY NATIONAL FIRE PROTECTION <br />ASSOCIATION BULLETIN. N.F.P.A. 329. <br />TEST <br />RESULTS <br />TANKIDENT <br />TANKIS TANKIS <br />TIGHT NOT TIGHT <br />LEAK RATE <br />G. P. H. <br />TEST DATE <br />9 THIS CERTIFIES THAT THE TANKS DESCRIBED WERE TESTED BY THE UNDERSIGNED AND THAT THE STATED <br />RESULTS REPRESENT THE TRUE STATE OF THE TANKS ON THIS DATE TO THE BEST OF MY KNOWLEDGE. <br />CERTIFICATE <br />CERTIFICATION SIGNED ISSUE DATE <br />FOR (TEST COMPANY) - — <br />ADDRESS !l!ANX Tsa 6'1'59�1[S OrI 3 <br />IP (L Gime 18th <br />' <br />VMS TATE <br />' e� <br />