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Data Chart for Tank System Tightness Test <br /> PLEASE PRINT <br /> 1. OWNER protan, / T )ZK' e <br /> II�� Atltlr Representative Telephone <br /> Tank(a)I]Y IAJ T S <br /> Name Mdre. Representahe Telephone <br /> 2. OPERATOR )rV Q/-- / 5a `N Tel -11140 <br /> Name Md. W <br /> 3. REASON FOR e— <br /> TEST <br /> (Explain Fully) <br /> 4. WHO REQUESTED <br /> TEST AND WHEN Name, Thus Company orAmllation Date <br /> Mare. Telephone <br /> Identity by Direction capacity NBm��uWllerGraceApprox.Age SeelMderglees5. TANKINVOLVED W 04 Suse atlditional ones <br /> for mamMidetl tanks <br /> Location Coyer Vents Slpiwn. Pumps <br /> 6. INSTALLATION W 6-S 7-OF <br /> DATA t3uylainJk �eoAr2t7E V Na 5Uc'T/on) <br /> Sl DEO/ Snlrs <br /> North inside driveway. Concrate.Bleck Top, Size,TtsBil make.Drop Suction,Remota, <br /> Rear of station,etc. Earth,etc. tubes,Remote Fill. Size,klenifolded Mich tanks? Make d known <br /> 7. UNDERGROUND Is rue water over the tank? <br /> WATER Depth to M Water <br /> �bible <br /> �..�y U 9. Ely.I ®No <br /> B. FILL-UP Tanks to be filled or�m r. Date Arrengedby Cl W. Name Telephone <br /> ARRANGEMENTS �'`tre protluct to`lop ore'end coat tank rearm. Now and who to promos? Consider No Lean. <br /> Terminal or oMm contact /J 7`y) t�Z:f ,'e= 1 T�.ap�LJ /a�. (�/� <br /> for notice or ingWry, li y 7 0xrr`/ N 2_61eT C4 GA/ <br /> Cmnpany Name Telephone <br /> 9. CONTRACTOR, <br /> MECHANICS, <br /> any Other contractor <br /> involved <br /> 10. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> Mdhional information on any items above.Officials or drum,to be admeM when testing is in progress or completed.vishors or observe,present during tact,W. <br /> Tests were made on the above tank systema In accordance with teat procedures prescribed for <br /> 11. TEST RESULTS as detailed on attached test charts with results as follows: <br /> Tank Identification Tight Leakage Indicated! Date Tes,d <br /> Op - off <br /> 12. SENSOR 13.This is to certify that mese tank systems were tsabd on that dab()tdtorni Those Indicated as"fight'meet the criteria established by the <br /> CERTIFICATION National Fire Protection Association Pamphlet 324 <br /> /� 57.J_ /\ �D Technician. /� /f�/� <br /> _ <br /> Daft l:.Ct 1 /yi93� .//L[?� wry OP 570_-::? � C.Cil Xm4t�.-0/�K , <br /> 1 a w� X Truro ContrMor m Company. By: SlgnaW, <br /> Small No of Thermal Certification 4/0•/8i�/oy�/ ��/LerSe L/AjCOL� ZS oCery.fJ GfF. <br /> Sen <br /> Add ws <br /> 2. <br /> confiscation a PN6827 <br />