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/ WORKSHEET FOR SUMITTAL TO GOVERNMENTAL AGENCY L <br /> OVNER/00ERATOR �f U��TC�</ �jQ-LC—� SITE ADDRESS 22- <br /> CIT <br /> COUNTY <br /> NAILING ADDRESS p /�!�, <br /> SITE ACEAI ��aJJ2//g-[ �GLt�s- TccJJ TELFrRONE �)_ <br /> ARRIVED TEST SIVP7c)`HoURS THANK LOCATION •'/ PRODUCT <br /> DATE/TIME STORAGE FILLED? Zp PRODUCT LEVEL AT ARRIVAL /I TNCRES BELOW Tor OF FILL NOMINAL TANK SIZE <br /> TANK MATERIAL // // <br /> =APFROS. TANK Ar V3-ITRS. FILLSI7.E/TYPE_�oVERFILL COHTATIBTP.ITP TTP`F, <br /> API GRAVITY 35 AT 71 DEC. F. - AFI GRAVITY OA+_7 P 60F - COEFFICIENT OF EKTANSION OF .000COE <br /> VISABLE VENTING ArPREARS TO BE Art ILL EFD ILL OrOSITE END, HAS BURT TUBE, RAS BALL CHER, UNKNOWN, OTRRR <br /> VISABLE VAPOR TRAPS TO BE BLED: BALL CHECKS, MANWATS, RETURN LINES, OTHER <br /> PRASE II VAPOR RECOVERY STSTENt BALANCED, ASPIRATOR ASSISTED, LONG RUN WELLS, MAHIFOLDED,�, p <br /> o TRPR <br /> PlMtPtFC SYSTEM: SUCTIOfl, PEPE LINE LEAR Detectors TES, Lpp; NOT Ar1LIC <br /> CHARTED SIZE 9f4w EST. LIFE QUANTITY <br /> __7 rRODUCT ADDED TO FLOOD STST�_ STEM TORAL CALLONAAGE/99'4 0 <br /> AMBIENT CONDITIONS! 7F}fP! PRE'RST7� POSERS?_ lT1HITY, OVOL ININC, WI1D1T, BREF. ICRP, OTHER <br /> .4 PSI DROIC XR/ OURS TEST TO STAR--//' PSI TO BE MAINTAINED ON TANK BOTTOM D INC TEST PERIOD S, O PSI <br /> A. GRADF. TO TARR BOTTOMz <br /> Q?� B. GRADE TO TANK TOP <br /> p <br /> sfAOE C. TARS DIAVETER 7Q/ <br /> 0. TEST LEVEL AM" CRAOE Z� <br /> • G�S7�l. ( e.•'Z§ �/ E. !STERU1 <br /> NAL CM0 VATBR AROVE TAM[ <br /> F /"p2 ROITH IM. 1 .0361 PSI <br /> F. TOP OF FILL TO rROO. AT ARRIVAL ' <br /> G. TOr OF FELL TO TOP OF TARS <br /> R. TPST'LERL'TO 10f OF TNIK / <br /> MATER 1 I /--'J PST PER INCH Of rM011Cr <br /> E TANK / TEST HEIUIT PRESSURE FORMULA <br /> REMARKS: N. PSI —E r5( NET r5t <br /> RESULTS <br /> THE L "I FST PF IOD AS SHOWN ON THE ATTACHED COMPUTER GENERATED DATA RFFI.F.CTS A <br /> LOSS / AI OF: LgGALLONS PER HOUR, WTTII A 99% CONFIDENCE LEVEL, OF 4-/- ,00/ Qph. <br /> THE HORNER EZY CHEK II . IHOD COMPLIES WITH EPA AND THE STAIE OF CALIFORNIA PERFORMANCE STANDARD OF 0.05 GPH <br /> FOR TANK INTEGRI TE INC. (S CTION 2643 CALIFORNIA CODE OF REGULATIONS) BASED UPON THIS STANDARD, THE RESULTS <br /> SHOWN ABOVE: ES NOT NDICATE AN UNAUTHORIZED RELEASE EQUAL TO OR GREATER THAN THE 0.05 GPH STANDARD. <br /> INTEGRITY TANK TESTING S VICES, 41 WEST YOKUTS ST. STOCKTON, CA.,/� W95207,) 2(209) 474-1375 or (8000r) /)262-�883�78, <br /> CERTIFIED TESTER STATE LICENSE R ao- -5 TEST DATE <br />