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Data Chart for Tank System Tightness Test <br /> PLEASE PRINT <br /> 1. OWNER Papery Gd Ps W7a rt has J/h d0 W�ig1� Y �o� $7�SA7 Cq �b X09 <br /> ISI Neme T / A a Address Lp —�r Reprewntativs TO.ph. <br /> Tankfe)YN �(1N� t14cr�rl' Y•s nHP J.09_9t5'/-;Ljq <br /> Name Address Zip Rapeiturshve Telephone <br /> 2. OPERATOR „ S&0r %0,y19 �e <br /> Name Address Zip Telephone <br /> 3. REASON FOR4JM— <br /> TEST <br /> (Explain Fully) ��oo <br /> 4. WHO REQUESTED <br /> TEST AND WHEN Name O rue c mynnieuon —9A�a/ <br /> Address ZI Telephone <br /> Identify by Direction Capacity Band/SupplierGreda Approx Age Stele/Fiberglass <br /> 5: TANK INVOLVED a er qn ODD a ? ee <br /> it <br /> We additional lines <br /> for m rri folded tanks <br /> Location Cover Fills 9 Vent.It Siplwnes Pumps <br /> 6. INSTALLATION Ike *e <br /> bevt /Jea tae Ptfl -1 � ryj Remmi-e <br /> DATA oC r w k-.t P_j. <br /> Gefy. y't $1 ' <br /> North Inside driveway, Concrete,Black Top. Size,Tiafill make.Drop Sualon.Remoa. <br /> Rear of station,etc Earth,etc. tube.Remote Rile Size.Miumfoae l wroth tablel Make if known <br /> 7. UNDERGROUND •/ Is the water mem the lank' <br /> WATER Depth to the water table from grade ry®N�f n yes No <br /> Tanks to be filled AIW a. 3� bate Arranged by 'Yes 4 h a -- <br /> B. FILL-UP I Name Telephone <br /> ARRANGEMENTS Extra product to"top airand run tank tete.. taw and who a pamdev Corrado,No Lead. <br /> —TPJi sea r 1e �1 v< 0 <br /> Terminal or other contact <br /> for notice or Inquiry "— <br /> Company Name Tetepnone <br /> 9. CONTRACTOR, <br /> MECHANICS, _ Ear-If a; <br /> any other contractor �!t _ <br /> involved <br /> 10. OTHER -- -- <br /> ----MAY 2 -1990 - <br /> INFORMATION <br /> OR REMARKS – <br /> Additional uumbro tnm oa any lams above.Officials or others to be advised when testing is in progress or completed 1 Uipqteil.e- <br /> ll. TEST METHOD ® PETRO TITE II I ❑ PETRO COMP ❑ QUICK CHECK 2000 <br /> Tests were made on the above tank systems In accordance with teat procedures proscribed for <br /> Ila. TEST RESULTS as detailed on attached teat charts with results as follows: <br /> Tank identification Tight NO Were,Charge Per hour Date Tested <br /> Car rttrorT-,* -11 <br /> H,S Ail`_ e5 . lao/6C2r-6?N, <br /> 12. SENSOR 13. CONTRACTOR CERTIFICATION AFFORDA - TE$T <br /> CERTIFICATION a iqi. 812 O STREET G f "0 "Y <br /> D�j tlALT:CA. 958 <br /> Data 1 <br /> / /(Q' 2 Q� Testing Connector tv anY. Sgnaare <br /> Sana,No.of Thermal Codification a -q/"r sa/`Z" 7 7 <br /> Sensaf 0 <br /> J T1 1-. �' Address <br /> Canigcaam a 0 'l PNW27 <br />