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THORNE ENVIRON TEL*oo . 916-784-7496 May..w8 ,89 17 : 14 No .005 P . 18 <br /> TTELESIS I -, ` ij�r-} to harbor Blvd., W. Sacramento. CA 95691 <br /> T*nk T*Mnyl �- —� (816) 372.7535 <br /> AINLAY TANK 'TEGRITY TESTER" FIELD TEST DATA <br /> 1 NAMEADDRESS PHONEQ09) QS <br /> TANK <br /> SuA:SE'I VJt l�r> 1� <br /> OPERATOR - ---- - -- <br /> 2 IDENTIFICATION CAPACITY-GALS MANUFACTURER STEELIFIBRGLS. AGE-•YRS, <br /> TANKS TO <br /> BE TESTED <br /> 3 WATER DISTANCE FROM GRADE TO WATER�'r� INS. <br /> TABLE <br /> 4 TANK WILL BE FILLED ITIMEI ON �'9S�'fe <br /> TANK EXTRA SGALS PRODUCT AVAILABLE FROM <br /> FILL•UP FILL UP TO BE ARRANGED BY MR, <br /> CONTACT AT STORAGE TERMINAL IS MR._-__- - ....._ PHONE 1 <br /> 5 NAME. ADDRESS PHONE <br /> OUTSIDE <br /> CONTRACTORS <br /> 8 NAME AUTHORITY <br /> OFFICIALS lJtuJ _'1zi' . 41,14 `t1Jti V�ialT- 67Y. / <br /> ( TO BF — <br /> CONTACTED <br /> /i r�<! �G.✓F7 H!P/N �r.i�e/ �.. /•t•� _5/'s iy Lr{! f ('N <br /> SPECIAL <br /> NOTES OR /lvar/O.�i-t►.vlc'ti+ {•�•1Y1-'S1. <br /> PRECAUTIONS <br /> 8 ALL TESTS WERE PERFORMED IN ACCORDANCE WITH PROCEDURES DESCRIBED IN SOILTEST'S <br /> INSTRUCTION BOOK. .CRITERIA FOR TIGHTNESS IS ESTABI.ISHED BY NATIONAL FIRE PROTECTION <br /> ASSOCIATION BULLETIN, N.F.P,A. 529. <br /> TANK(DENT TANK IS TANK IS LEAK RATE TEST GATE <br /> TEST ncH NOT TIGHT 0, P. H. <br /> RESULTS ", Opr <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 OATE TO THE BEST OF MY KNOWLEDGE. <br /> n CERTIFICATE NO. <br /> CERTIFICATION SIGNED ^ D! i o y — ISSUE DATE <br /> e <br /> $ FOR(TEST COMPANY) <br /> ADDRESS <br /> STATE ---_....._...--- ZIP <br />