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.T TELESISc <br />�.r 1450 Her Blvd., W. Sacramento, CA 95691 <br />Tank Testing (916) 372-7535 <br />AINLAY TANK `TEGRITY TESTER"" FIELD TEST DATA <br />� <br />1 <br />�✓1 ♦I fi/l� ff/S,%E.rFj <br />�lJ�'/iy <br />SPECIAL <br />NOTES OR <br />TANK <br />a°P.✓� �Cs�d <br />._. <br />OPERATOR <br />4 0✓� <br />2 <br />PRECAUTIONS <br />TANKS TO <br />BE TESTED <br />t •. <br />8 <br />3 <br />WATER <br />IN SOILTEST'S <br />TABLE <br />IS ESTABLISHED BY NATIONAL FIRE <br />4 <br />ASSOCIATION BULLETIN. N.F.P.A. 329. <br />TANK <br />FILL -UP <br />5 <br />OUTSIDE <br />CONTRACTORS <br />0 <br />vo <br />OFFICIALS <br />TO BE <br />CONTACTED <br />IDENTIFICATION I CAPACITY—GALS. I MANUFACTURER I STEELIFIBRGLS, <br />DISTANCE FROM GRADE TO WATER INS. <br />TANK WILL BE FILLED ••4 (TIME) ON % <br />EXTRA 5 GALS PRODUCT AVAILABLE FROM ?Cz:ff%J Z <br />FILL UP TO BE ARRANGED BY MR. /w <br />CONTACT AT STORAGE TERMINAL IS MR. <br />NAME ADDRESS <br />AGE—YRS. <br />PHONE( r/6) tr <br />PHONE( <br />PHONE <br />PHONE <br />i.l.� -Cr A"n j /A G <br />7 <br />� LL LLe p� <br />�✓1 ♦I fi/l� ff/S,%E.rFj <br />�lJ�'/iy <br />SPECIAL <br />NOTES OR <br />�i dL �/'�i�%S/b♦r% <br />a°P.✓� �Cs�d <br />._. <br />oD � $ ! �$ <br />4 0✓� <br />PRECAUTIONS <br />t •. <br />8 <br />ALL TESTS WERE PERFORMED IN ACCORDANCE <br />WITH PROCEDURES DESCRIBED <br />IN SOILTEST'S <br />INSTRUCTION BOOK. CRITERIA FOR TIGHTNESS <br />IS ESTABLISHED BY NATIONAL FIRE <br />PROTECTION <br />ASSOCIATION BULLETIN. N.F.P.A. 329. <br />19 <br />TEST <br />RESULTS <br />CERTIFICATION <br />TANK IDENT <br />TANK IS TANK 15 <br />TIGHT NOT TIGHT <br />LEAK RATE TEST DATE <br />G. P. H. <br />A141 /a0100 OWK OejWay <br />— -fp <br />� '�� 000 ♦ <br />._. <br />oD � $ ! �$ <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 />FOR (TEST COMPANY) <br />ADDRESS <br />CERTIFICATE <br />ISSUE DAf9% <br />o ® r., .'fn.�TATE ZIP <br />Eravl�n^ nn[ <br />PERMIT / <br />