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MAY 2 9 1992 Data Chart for Tank System Tightness Test <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/b€twit:€q1 <br /> PLEASE PRINT .f <br /> 1. OWNER pmpem/❑ t1�Y 1 _.� l /a .psn.gr,r 1 L9fi �— <br /> +Name aC{°as LP Repreen a Telephone <br /> Tankla)❑ 11 k /N ' �. a/9 ._ <br /> 'Name R.Parowarnifins Toephone <br /> 2. OPERATOR Neme` Address ng ei.pnone <br /> 3. REASON FOR P <br /> TEST <br /> (Explain Fully) <br /> 4. WHO REQUESTED , Compmyor Aallie0an Doe <br /> TEST AND WHEN N.M. <br /> Address Zip Telephone <br /> Identify by OlrKeon. CapacityBrendrsuppller Grade toe S it Aplxos.Age siwllFlbergtan <br /> 5. TANK INVOLVED It <br /> Use additional lines <br /> for manitolded tanks <br /> Location ver ` Flllf s' Van^ I/ SIP. n PumpsR� <br /> �aQ <br /> 6. INSTALLATION 7:P? I��t"V� <br /> DATA Opt et k O <br /> Ste rQ <br /> North Inside driveway. Concrete,Slack Tap. Sae,Titelill make.Drop Suclbn,Remote. <br /> Rear of station,etc. Earth,oc. tube.Remote Fills Size,Menllolded Which tanks? Make it known <br /> 7. UNDERGROUND 10 e)A 1 is the water war the tank? <br /> WATER Depth to the water <br /> table <br /> fr�from <br /> grade / G� '^ � � e v` ❑vn <br /> 8. FILL-UP L�No <br /> Tanks to be filled(j./aa h,.(! a^ Z Data Arranged by Name Telephone <br /> ARRANGEMENTS Eon product to'Y off'and mss tank testes. How and who to provide? Consider NO Lead. <br /> Terminal or other contact <br /> for notice or Inquiry Company Name Telephone <br /> ' <br /> 9. CONTRACTOR, <br /> MECHANICS, <br /> any other contractor <br /> involved <br /> 10. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> Mdilionel information on any Items above.OHicieb or omen to he advised when tearing Is in progress or completed.Visitors or obwrmn pmenl during test.rec. <br /> 11. TEST METHOD 10 PETRO TITE _1/ I ❑ PETRO COMP ❑ QUICK CHECK 2000 <br /> Tests were made on the above tank systems In accordance with test procedures prescribed for <br /> 11a. TEST RESULTS are detailed on attached teat charts with results as follows: <br /> Tight Net Volume Charge Per Hour Data Tested <br /> Tank IEanrlllution 9 <br /> 12. SENSOR 13. CONTRACTOR CERTIFICATION <br /> CERTIFICATION t _ <br /> —9/ 05%0/ 5 <br /> Signal..No.of ThermalCartiutlon• /a�J/v{�r/Y rr �e/ _,�Oty/I V°-I eq <br /> Sensor tutu AddrMe <br /> PNW27 <br /> Certification 0 <br />