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VM\V V e • eV• eVeee\ V'V\Vee• eeyee. •VV •VV\ , <br /> petro Tite <br /> PLEASE PRINT TANK TESTER <br /> 1. OWNER Property ®© 42 <br /> Name"• e Add,ws Pep,esenutire <br /> Tank(s) ste <br /> Noma Add,ess Representative Telephoto <br /> 2. OPERATOR r f-- S <br /> "Greek <br /> Name <br /> 3. REASON FOR is, <br /> TEST <br /> (Explain Fully) <br /> 4. WHO REQUESTED r . F/est -/ - <br /> TEST AND WHEN Na Titie C;V4 o,A illation Date <br /> Address Telephone <br /> 5. WHO IS PAYING aa, }0—if - <br /> FOR THIS TEST? Cnc,of 1;94Parson Autllodeme Ties Teupnone <br /> olnwny.Ae. <br /> 91111"Address Clry so" Zip <br /> Attention of: Deer No. Other temptations <br /> Identity by Direction Capacity Brand/Supplier Grade Approx.Age Staal/Fiberglass <br /> 6. TANK(S) INVOLVED W St O rL <br /> E ST <br /> Location Cover Fills Vents Siphones Pumps <br /> 7. INSTALLATION _5 FA SP ( ewe ifr< te .7 ,I tJAl1N < <br /> DATA _S 4, A-5r OPo0 +04fe- Life f-.-c.aJ <br /> North Inside driveway, Concrete.thick Top. Size,Titeflll make.Dlop Suction,Remote, <br /> Ree,of millpn,etc. 6M.etc. lulms.Remota Fill. Size,Manifolded Which tanks? Make If known <br /> 8. UNDERGROUND Is the water over the tank? <br /> WATER Depth to the Water table Ai O N L [] yep ® No <br /> Tanks to be filled R po hr. J1 —J 7 Data Arranged by�S t Ill d\ fel/k n i e .2 --1 <br /> 9. FILL-UP Name Telephone <br /> ARRANGEMENTS Extra product to"top oto'and run TSTT. Mow are who to provide 7 onsider NO Lead. <br /> VFC�Pik <br /> Terminal or other ContKiIT(ts LY/ I <br /> for notice or inquiry 1 <br /> Dalnpaey Nom Telephone <br /> 10. CONTRACTD PR 1997 Nj1 <br /> MECHANICS, 0M <br /> any other contractor E <br /> involved t PIS ll <br /> 11. OTHER k� el <br /> INFORMATION <br /> OR REMARKS <br /> Additional information on any items above.Officials w others to be advised when testing is in progress or completed,Visitors or observers present ' <br /> during test etc. <br /> TMs were mads on the above tank systems In accordance with test procddurss prescribed for PPLro T Le <br /> 12. TEST RESULTS me detallod on attached toot Charts with results as follows: """ <br /> Tank Identification Tight Leakage Indicated Date Tested <br /> ee re ks��� s e L - - b <br /> - 7- <br /> Me 5 <br /> This Is to CMtlry,Mal Mose tank systems were tested on the details)shown.Those indicated as"Tight"meat the criteria established by <br /> 13. CERTIFICATION the National Fin Protection Asocistion Pamphlet 329. <br /> Tlrty CAfeS C Yy OF .5.f40,e- + ��.✓ <br /> Dau Ustin9 ComtaCompany. y: <br /> ga,a,Copanto runi ta <br /> Ad �u.g71eWmTSQ& ,u <br /> 3errser <br />