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WORKSHEET FOR SUBMITTAL TO GOVERNMENTAL AGENCY <br /> ^ <br /> OWNER/OfF.lUTOR �y c/?F�P7._ �d L��/� SITE ADDRESS aC5k C <br /> AA o coNNn_ <br /> NAILING ADDRESS <br /> SiTE AGENT _-/7a 4i OC 7a_ T'(y�_ yyyy TELEPHONE [!�2E)_ ����/// <br /> ARRIVED TEST SITiiwROURS TANK LOCATION_ , y'/ FRODtlCi !/ G /6�-!•-/�J-0 <br /> DATE/TINE STORAGE /tRODUCT LEVEL AT ARRIVALZ_7INLTES BELOW ,T/OP OF FILL I"fINAL TARE SIZE 7G�D <br /> 7ANK MATERIAL��.R 'L�lX- MtBOK. TANK AC,Lr�TRS. FIL.LSIZE/TTPE y' OVERFILL CONTAINMENT FIEF. <br /> , <br /> ATI GRAVITY�I 6 AT O`er DF,C. F. - API CRAVI7T OF60F - COEFFICIENT OF ERPARSION of ,000 L 73 ZO COE 6 73_ <br /> VtSABLE VENTING ArPREAAS TO BE AT, riL END FILL OPOSITE END, HAS BURP TUNE, HAS BALL CHECK, UNKNOWN, UTNFTI <br /> viSARLF. VAPOR FKArs IO BE BLED! BALL CNECRS, MARWAYS, RETURN LINES, OTHER �7•I <br /> PRASE II VAPOR EECOvERT BTs,"j, ALANC® ASPIRATOR ASsIBTED, LANG RUN WELLS, MANTFOMED,• NONE, OINERSrd.�BG'� <br /> PUMPING STRTM! SUCTION, TURBINE MARE I1���7.//7 MODEL S� PIPELINELEAR Detectors 7P.Si NOT:rI NOT ATTLIC <br /> CTIARTTTI 517.E �9S7 EST. LINES QQJUANTITY 7p5` PRODUCT ADDED TO FLOOD SYSTEM N SYSTEM TORAL CALLONAGE-`.3f 7O <br /> AHBILTR CONDITIONS! TPM', PRETEST B/ rOSTEST (J SUNNI, CLOVIR, RAINING, WINDY, BREEZY. NICRT, DINER _ <br /> .4 PSI DRO&30 ROUR.S TEST TO STAR/,J3ONOURS PSI TO BE MAINTAINED ON TANS BOTTOM DURING TEST PERIOD rst <br /> _ A. CPAPF. TO TANK l(OlVR <br /> R, LTADE TO TANK TOP <br /> C. TANK DIABETTA 75 <br /> 6.Pifpl <br /> Tr7''TDES <br /> , TT L.P"t AMY@ CRAVE <br /> • 33 - 1 // e 3 E. EK7ERNAL CROUIV NATER ABOVE 7ANK <br /> BOrrm Iw, K ,O]AI rst - <br /> /� O P. Top or FILL To TAM. AT ARRIVAL /'�1 <br /> C. TOP OF FILL To Tor OF TANK .3J <br /> Ttrr'l2TEt-TEE imam oR TANK��J� <br /> TNOR I t! ✓ PSI rPR IROI of rRVURT r-r`^'– QZ6� <br /> — — TEST HEIaO PRESSURE FORMILA <br /> ice. K 75-1 � _ 3. 5 <br /> REMARKS: yo dee_ Tu °. rsI rsl NF rsi <br /> Cfi'QGG6•C.J.�.r TZS T'8�� ,LL7l6Z /42�i'Zfl`. �7JiP.Ej/AJ�' �L�Ait-'01�LXJ C <br /> amp <br /> J U L 3 1 191 <br /> ENVIRONMF,NTAL HEALTH <br /> RESULTS PERM)T%SS {{��VI((''L�" <br /> 'TIRE, FINAL '1'ES'I' PERIOD AS SHOWN ON THE AIIACHED COMPUTER GENERA���'Y) f5K1'�A REFLFC'I'S A <br /> clo <br /> S / GAIN OF��[LGALLONS PER )TOUR, WITII A 99% CONFIDENCE LEVEL OF +/- .Ool Kph. <br /> 771E KORNER EZY CRIER II T THUD COIfrLIF.S WITH EFA AND THE STATE. OF CALIFORNIA PERFORMANCE STANDARD OF 0.05 GFH <br /> FOR TANK INTE�RIRIIr�y TES ECTION 2643 CALIFORNIA CODE OF REGULATIONS) BASED IPPON THIS STANDARD, ME RESULTS <br /> SHOWN AAOVE: �V✓' �' - ES NO INDICATE AN UNAUTHORIZED RELEASE EQUAL TO OR GREATER THAN THE 0.05 GFH STANDARD. <br /> INTEGRITY TAN""KVV✓TESTA . RICES, 166 FRANK WEST CIRCLE, STOCKTON, C/A�., 952J06, (209) 466-8036 or (8 O) 26;-8378 <br /> CERTIFIED TESTER WI/ STATE LICENSE 0 qV /01-3 TEST DATE Z37 <br />