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Data Chart for Tank System Tightness Test <br /> petro TAW <br /> ^ TANK TESTER <br /> 1. OWNER Propeny C�OiT AwdER / 1141t) EiYTEaQ"� g6 <br /> Tank11 <br /> a Name S-To.� a Address Telephone <br /> Name Address Telephone <br /> 2. OPERATOR SAME: <br /> Name Address Telephone <br /> 3. REASON FOR TEST <br /> (Explain Fully) <br /> 4. WHO REQUESTED `Cb w4jeps _ OWNER <br /> TEST AND WHEN Name Title Company of Affiliation Date <br /> Address Telephone <br /> 5. WHO IS PAYING SAME AS fled/€ <br /> FOR THIS TEST? Company,Agency or individual Perron Authorizing Title Telephone <br /> Billing Address City Slate Zip <br /> Attention of: Order No. Other Instructions <br /> 6. TANK(S) INVOLVED Identify by Direction capacity Grade Approx.Age St"11Fiberglass <br /> GEST a� �haa 5� :gig) Qs Se7E'E/ <br /> 7. INSTALLATION Location Cover Fills Vents Siphons Pumps <br /> DATA wasr za )}C4, NOME 30C7ibAl <br /> North inside ddvilway, Concrete,Bieck Top, Size,Mae make,Drop Suclon.Remote. <br /> Rear of statian.Mc. Earth.Mc. tubes.Remote Fins She,Maniidded Whin tanks? Make it known <br /> 8. UNDERGROUND ij Is the water over)the lank? <br /> WATER Depth to water table IF known ! L1 Yes l9 No <br /> 9. FILL-UP Y 23-$q tae va 8:1 MIA . <br /> ARRANGEMENTS ranks towfillea Data Arranged by Tetephone <br /> Hour <br /> 10. TECHNICIANS <br /> 11. OTHER <br /> INFORMATION <br /> OR REMARKS MAR 04 1�391 <br /> ENVIRONM HH <br /> — MII RV/SE ICES <br /> Additional Information on any Items above.Officials or others to be advised when testing 19 In progress or completed.Visitors or observers present <br /> during teat,etc. <br /> 12. TEST RESULTS Tuts were made on the above lank systems In accordance with Int procedures prescribed for eft 711P <br /> as details on attached Int Chart$with reolpi as follows: <br /> Tank Identification Tight Within Tolerance Out of Tolerance Date Tested <br /> 13. CERTIFICATION This Is to codify that then pink systems were holed on the dateO shown.Those Indicated es"Tight"meet the ciliate estebh.h.d by the National Fire <br /> Protection Association Pamphlet 32e. <br /> 9.O _ Name of person certifying <br /> Date %dlrE 'o Jtwt lElo Dellqo, <br /> - f Testi Contractort Po" <br /> a <br /> 7. Pery. V Slynary re <br /> Mo' ZO�z XCerillutlon Number Address P <br /> /45 35/ �1. .(�i,14d ,? o v sz�ln <br /> Serial No.of Thermal Sensor <br />