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Data Cort for Tank System Tightnts Test. <br /> petro Trtel <br /> PLEASE PRINT TANK TESTER <br /> 1. OWNER Property ❑ 1;7oll W <br /> O Nam• A 11•prUMPo.or Yale";" <br /> Tanks) <br /> Name Address 11e01.110" live Telephone <br /> 2. OPERATOR- i M ` 000 <br /> Name Adduss hiaphe e <br /> 3. REASON FOR, <br /> TEST <br /> (Explain Fully) <br /> .4. WHO REOUESTEO -Tiyr t (u "ID- <br /> TEST AND WHEN Name Tine company of Allllhdon Del. <br /> Adders T•behene <br /> 5. WHO IS PAYING <br /> FOR THIS TESTI Com mY.Apmcy o,lndlvldu.l Pv,an AuthpNine Tine Teleenene <br /> 61111np Addnu City Sum <br /> Attention of: Old.,No. Oln.r In,llu=npn, <br /> 1 entity by Okection Capacity Brand/Supplier Grade Approx.Age XNet/Fiberglass <br /> 6. TANK(S) INVOLVED x000 f7 <br /> Vk F ! <br /> l <br /> Location Cover Fills Vents Siphon., Pumps <br /> 7. INSTALLATION �jant O� //?��� � /- _ <br /> DATA S .} 6jnytGL f it 2" c 1 vfCGt ea'w? <br /> Norah ImNe erlveway, Connate.61aex Top, She,Tl'a mete."op <br /> Suctlon,Mme,e. <br /> Rea of aNti.M1 ... Es' eN. ,e.eA e.moN Fllia Sia..Mmifolded WMah tanb P Make it mown <br /> S. UNDERGROUND 1.the were,ever the Nnky <br /> -WATER Depth to the Water table Y., <br /> Yea � NO <br /> 9. FILL-UP Tanks to be filled - vv hr. �0 1Zb.to Arranged by V1 «-- <br /> Nemo f•lepnone <br /> ARRANGEMENTS Extra product to"top orf••and run TSTT. Now and who to provide y Confider NO Lead. <br /> Terminal or other contact <br /> for notice or IgQYIP/ <br /> Company Noma Tebpnone <br /> 10. CONTRACTOR, <br /> MECHANICS. <br /> any other comucto, <br /> involved <br /> 11. OTHER <br /> INFORMATION C fa !. ,/ <br /> OR REMARKS <br /> Additional information on any items above.Officials or others to be advised when toting is in prophet or complebd.Visitors or observers Pasant <br /> during test sic. <br /> Tests were made on the above tank systems In accordance with lest procedures prescribed for1r0 11P <br /> 12. TEST RESULTS as detailed on attached test charts with results as follows: �ro,T <br /> Tank Identification Tight Leakage Indicated Date Tested <br /> P&V T(t <�cd t +- o h It- - <br /> awl[ 4tq4tV It)- <br /> 13. CERTIFICATION This Is to certify that these tank systems were tested on the date(s)shown.Those Indicated as-'Tight--meet the crit ■tateblished by <br /> the Nallonal Fire Protection Aeoclallon Pamphlet 329. <br /> peas Lawrence Tank Testing , IA <br /> P.O. Box 407 ale lar <br /> 5ina1"° a <br /> senator .can,=.an, Downieville,California 95936 (916) 289-3109 <br />