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I n <br />liAACWN1401 Halms Dr., #130,W. Sacramento, CA 95691 <br />( Tank Testing& Service Station Maintenance (916) 372-7535 <br />J , AINLAY TANK 'TEGRITY TESTER'" FIELD TEST DATA <br />TANK <br />OPERATOR <br />2 <br />TANKS TO <br />BE TESTED <br />IDENTIFICATION I CAPACITY -GALS. I MANUFACTURER I STEEL/FJaRG" I AGE -YRS. <br />'' WATER DISTANCE FROM GRADE TO WATER ISO 1" INS. <br />TABLE <br />TANK WILL BE FILLED (TIME) ON OI II I QI <br />TANK EXTRA 5 GALS PRODUCT AVAILABLE FROM P"U, ci <br />FILL -UP FILL UP TO BE ARRANGED BY MR. �, �i <�t PHONE ( ) <br />CONTACT AT STORAGE TERMINAL IS MR. ~t—Pye?! o,Le PHONE( 9/4 i Pq/- VYSY <br />_ N Pvv-f <br />5 NAME ADDRESS PHONE <br />OUTSIDE <br />CONTRACTORS <br />i NAME AUTHORITY PHONE <br />OFFICIALS _ .SCn�T_Q;=.Cnc.11y� <br />TO BE Szti Toz c?",,.. Local lltcilEL% <br />CONTACTED PoBox �no9 <br />max._ <br />SPECIAL LVAtLev, T-e.blC. 121 pwvterr-JAS ` ' 'll <br />NOTES OR $ <br />ACL 3 Tc wr 7BssFa( i6iy bdaa. 9rodm <br />PRECAUTIONS ENVIKCi. <br />Ia ALL TESTS WERE PERFORMED IN ACCORDANCE WITH PROCEDURES DESCRIBED IN. SOILTEST'S--C- <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 />TANK IDENT TANK IS <br />TIGHT <br />TANK IS LEAK RATE TEST DATE. <br />NOT TIGHT G. P. H. - <br /><C J< <br />- <br />t 02 0/-// 9,0 <br />_dL< <br />aa <br />— <br />—021/ <br />by <br />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 NO. ZQo,2 <br />CERTIFICATION SIGNE / /yae ISSUE DATE <br />FOR (TEST COMPANY)WMICON <br />ADDRESS Tank Testln9&SerA"St IIm Melnlemna <br />P.O. Box 1024 <br />West Sacremento. Calitomia 95691 <br />