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Data Chart for Tank System Tightness Test <br /> pPfro Titch <br /> PLEASE PRINT TANK TESTER <br /> 1. OWNER p.opotr m e C L <br /> wdd.s Red....nn u.• T.I.onon. <br /> Tank(.) © N ,req rr r r`<<Q, <br /> N•'^• Ad°rw R.or.unt.nr. Tel <br /> 2. OPERATOR <br /> NLn• Address Tel....n. <br /> 3. REASON FOR <br /> TEST <br /> (E.plain Fully) <br /> 4. WHO REQUESTED <br /> TEST AND WHEN "•°I• rese compacr of Affiluto. on. <br /> Add,... Tares.... <br /> 5. WHO IS PAYING <br /> FOR THIS TEST? ­P Mdnmun select.Aufhd,unq res. n.onena <br /> Billing Address City Saw 21C <br /> Attention of: - Order No. Omer Inttryetbna <br /> Identify by Direction Capacity Brand/Supplier Grade Approx.Age Stesl/Fiberglass <br /> S. TANK(S) INVOLVED woorrm -raW e V,ee,,n %eo.0ir As <br /> &MOLe ? yc+g <br /> Location Cavo Fills Vents Siphon.. Pumps <br /> 7. INSTALLATION 4R0iU Tc.Ar CeAlc&e7re .�/ 11 „ A 131 k <br /> DATA </QApo� .2 TuR link <br /> Nctnh time.ddrlwer. c..o.wBlack toe. sir..Tltetirl mab,bringSuction.bmou <br /> Rreal of stage, I., Ea.nh,etc. .be..R.mol.Fill. Sire.Mentors" Which tank$ Mab d knorn <br /> B. UNDERGROUND I.the w.tef over In.tank <br /> WATER Depth to the Water ableZfw/K Cl r.. 0 No <br /> Treks to be filted 040n sec rT-/4-�7 Dat. Arranged by F<MTN y <br /> 9. FILL-UP - N.m. r.lr°non• <br /> ARRANGEMENTS Fella product to"top eft'and run TSTT. Now and who to provide? Comical NO Lead. <br /> /- 7-r./ <br /> Terminal or other contact <br /> for notice o Ineuiry <br /> Caere." Nr.. Telephone <br /> 10. CONTRACTOR, <br /> MECHANICS, <br /> any other contractor <br /> nroN.d <br /> 11. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> Additional inlermation on <br /> any item.abev..DIIICIaIs or others to be adviard when testing is in progress or Completed.Mailers or ebs.ners piston, <br /> during teat etc. <br /> Testa were made an the above tank systems In accordance with teal pr <br /> Procedures prescribed for O TI <br /> 12. TEST RESULTS a detailed on attached test Charts with results es follows: '�tFo -1tP <br /> Tank Identification Tight Leakage Indicated Dat.Tested <br /> fill " -/ I- y 1--/"-�7 <br /> u tee 4 n <br /> 13. CERTIFICATION This is to cetity that these tank systems wen tested on the delete)shown.Those Indicated as"Tight'meet the criteria established by <br /> the NationFire Protection Asociapon Pamphlet 329. <br /> " . <br /> Dm g .� <br /> Lawrence Tank Testin <br /> g �L< CTy'•'yi.� <br /> :rr-^ P.O. Box 407 <br /> s. °"° a Tn•mN •Phn�i••• Downleville,CCllfornla95936 (916) 289-3109 <br /> Sm.w <br />