Laserfiche WebLink
o L Data oart for Tank System Tigfoess Test <br /> pPfro ut-e <br /> PLEASE PRINT TANK TESTER <br /> 1. OWNER Property ❑ L �� _C� Onl-. 7c..-1 �. ._r_- <br /> �N ,�yyAe..... ......nulrre Teieonone <br /> Tenets) ❑ I/'�e LC-4— ---- <br /> Address R.wo.nuuv. Tell, <br /> 2. OPERATOR — <br /> Name AddressT.upn.n. <br /> le <br /> 3. REASON FOR ��� -- <br /> TEST <br /> (Eapl•in Fully) <br /> 4. WHO REOUESTED 1N z �1UCo 'Y/V/ <br /> TEST AND WHEN T..e p nni any w An.ren.n Due <br /> .mw Alcon. <br /> 5. WHO IS PAYING eom ^e A,h1.1 ine.ie a P.r,.�A.m. 6a�1 �n�� T.— <br /> FOR THIS TESTI <br /> Bunny Adeu.s Ole Buta Lo <br /> Anenuon Ol Orde,No O'n'.Innrucuont <br /> enol D Dnecn n Capacity Bla/�djfCuDPher rade C APProa A e Step+aryl s <br /> 6. TANK(S) INVOLVED �a' �' GU1? <br /> �htion Cover Fills tram, BlptonesPlumps <br /> 7. INSTALLATION I 4"1vl 5(pA., ��� <br /> DATA <br /> uy <br /> Nunn mild.d—i--.,. C.nnne Brack Top5.[e.Titerai m.s. moo S.n�.� aemote. <br /> Ren.l tlenon alc E.nn elc I.Oes Remote ftlN Sne M.".1ded Which l.n\sr Me,e it Yne.'n <br /> 6. UNDERGROUND 1.rt�he water over the tank? <br /> DWATER Depth to the Wile,table Yes r X No <br /> Tanks to be filled hr an <br /> Date An ged by 1 '\ <br /> 9. FILL UP Name Te•epn°"e <br /> ARRANGEMENTS E.ve product to"top oll end run TSTT. Now and who to provide 1 Consider NO Lead <br /> Terminal or other contact <br /> for nonce or inquiry Como•ne N.I. iekpn.ne <br /> 10. CONTRACTOR, -- <br /> MECHANICS, <br /> any other contest., <br /> my.l.ed <br /> 11. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> Addpbonal information on any items above.Officials or others to be advised when tasting is In prppress Of completed Visitors or ubselvers present <br /> during test etc. <br /> Testa- made on the.troy.tank systems In accordance with teat procedures Prescribed for P—et T1ir <br /> 11. 'TEST RESULTS me dslalW on attached test Chula with results as follows: <br /> N Identification Trp L.•k.ge Indicated Date Tesre <br /> Tills In to can at the nk systems w tad on the oalgs sh n. nolo as-Tight.,meet the crflerb established by <br /> 13. FI the r Aeocis: la 329. 1 <br /> get. �I,Ie,,, l r Triunac��.r�F°i, 7�ifJ!E'.F'llb sron.wr. <br /> Uk <br /> Beer No d7Thsmai lannicum I Add,l <br /> i'/, L ^..fl (''� :IA 958:3 <br />