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Data (:hart for Tank System Tightness Test <br /> petro TOP <br /> PLEASE PRINT ANK 'ESTER <br /> 1. OWNER Property L — <br /> err_-i_ r= Add.. <br /> Name <br /> Tank(s) � Rwn.anuuee Taleonana <br /> Nam. AOCraai R.OrManuee. <br /> Tal.onon. <br /> 2. OPERATOR <br /> Nam. 4ddr.te <br /> 3. REASON FOR T.iwhon. <br /> TEST _t-4L <br /> (E.Plaln Fully) <br /> 4. WHO REQUESTED <br /> TEST AND WHEN Nam. =U n. Comeerry or Ann.uon <br /> _ oats <br /> Aeerm iM.onone <br /> 5. WHO IS PAYING SG <br /> FOR THIS TESTI ante Ae r Iralraeel L P.rwn Autharkdre P rine T«.hon. <br /> fining Address Ciry sun Zip <br /> Attention of; Orden No. one.,Intervention. <br /> Identry by Direction Capacity Brand/Supplwr Grade Approa.Age Steel/Fibenglas <br /> 6. TANK(S) INVOLVED Sti j7w 0 fLLt= -/ Sir <br /> O , u /ir2 I Irl`( STrz'FC <br /> F 3 tcfcc() - (ICA rL 91rpt_ <br /> Location Cover FiIA Vents Siphons Pumps <br /> 7. INSTALLATION F2Dti — o F <br /> DATA ec Ncp'Fi/'}� y I I 2-1( Rhi 0TA-C K6,r <br /> Notm INId.pnyWay. Concrete,aim Top. Sire.Tinnll make.0100 Suction.Remote. <br /> Fear of station.Mc. Fenn,M. upm.Remale Rib Sin.M.nrolded Wlnw r.ka I Make it known <br /> 8. UNDERGROUND Is the watts over tele tank? <br /> WATER Depth to the Water taablleer[� yes ❑ No <br /> Tanks to M filled O•FPV hr. z.•2 7-9l L Dab Arranged by lCA r"y <br /> 9. FILL-UP Name T.I..hon. <br /> ARRANGEMENTS Extra Product to-too off"and run TSTT. How and who to provide r Consider NO Lead. <br /> Terminal or other contact !� I -� /� <br /> far notice crmcluVN <br /> y 2 Al ro <br /> Comeenv Nam. imapnone <br /> 10. CONTRACTOR, <br /> MECHANICS, <br /> any*then contractor <br /> involved <br /> 11. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> Additional intormatgn on any items above.Officials or others to W advised when coined is ,n progress or compled".Visitors or obeervets present <br /> during test sic. <br /> Tests won made on the above tank systems in accordance with toot Procedures Proscribed for <br /> 12. TEST RESULTS as detailed on anadhea tut charts with reruns as follows <br /> Tank Identification lati I Leakage Indicated Oats Tested <br /> t.' :L ) — srio <br /> h tk h 2C S- - '?I- <br /> t, ( <br /> t, ( — _ z <br /> This is to eeMlfy that theme tank Systems wen baud on the data($)shown.ThoN indicated as 'Tight'most tM cntenu established by <br /> 13. CERTIFICATION the National Fin Protection Aaocianon Pamphlet 329. <br /> , v�,� KO, OL, Lawrence Tank Testing <br /> P.O. Box 407 <br /> 12 Y H -72 7 - 9I Y signatpt. <br /> sM No On Th T.hnicum. Downieville,Califomia95936 (916) 289-3109 <br /> senser <br />