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WORKSHEET FOR SUBMI'[TAL TO GOVERNMENTAL AGENCY <br /> OWNER/0 IIATOR TE ADDREy S <br /> CITY_,N o COUNTY <br /> MAILING A RE S �7 6 <br /> SITE AGENT ff�"��/YC2 !C On��� TELEPHONE C-L) <br /> ARRIVED LEST BI71JIGURS TANK LOGTIOi/NUImSR '^ / ' � Uu T <br /> DATEITIME STORAGE FILLS OAo�' s 9 yP�RODULT LEVEL. ATT ARRIVALJLIJNCNES FE(L,OON TOP OF FILL NOMINAL TANK SIZE /-�7o <br /> C d -- <br /> TANK MATERIA, <br /> � �/ Q^"9'- APPROX. AGEJCtI ISS.��FILL SIZE/TYPE.._— OVERFILL CONTAINMENT TYPE <br /> API CRAVITTAa 0O AT�DEC. F. • API GRAVITY OPIYJ eI GOP • COEFFICIENT OF EXPANSION OF: SCOE OFY J�/ <br /> VISABHE VENTING APPEARS TO FE AT: FILL END, E� ISL OPPOSITH ENE UNKNOWN,TUTS, UNKNQ , HAS A BALL CHECK, OHIE&2' •*••'��r' <br /> VISAALE VAPOR TRAPS TO Be BLED: SALL CHECKS, MANNATS, OTHER <br /> PHLISE II VAPOR REAVERY SYSTEM TYPE: BAL7DQASPZM70R ASSISTED IANC ROI WELLS -HANIFOLDES� DOTER <br /> PUMPING SYSTEM: SUCTION TURBINE MAKE Go-Y2�tLu�'i MODEL -�`�C `� PIPE LINE TEAR DETECTORS 'V_}l <br /> CHARTED TANK SIZELII//II QQ4C—ESTIMA7H0 LING QUANTI7Y��RDDINCT ADDED 10 FLOOD SYSTEM •� ST51EM GALLONS 70 —, -- <br /> AMBIENT WEATHER CONDITIONS: TEMPERATURE PRRTPSt-vr0ST TE37O-c <br /> RAINING CLOUDY WINDY NIGHT OTHER .� <br /> ��g�q[/,5q �� <br /> SYSTEM FIAODEDYLLILNOUR4 .4 PSI DROP/jVlOH0UP3 PSI TO BE MAINTAINED ON TANK 80770M DURING NEST PERIOD � <br /> A. GRADE TO TANK BOTTOM ?)'%���y <br /> B. GRAN TO TANK TOP <br /> O C. TANK DIAVEYER <br /> 6.Pi1.DE Ai <br /> - ----N �� - D. TEST LEVEL ADM GRADE <br /> &IE <br /> D e. lxTePN11L CRO WATER ABOVE TANK j►/ BO1T01 'IK, K .0761 P31 yP. TOP OP FILL TO PROD. AT ARRIVALf'A� C. TOP OP FILL TO TOP OF TANK44(ry/17� H. TEST IEVEL'TO'BOTTOI OR TANK ` 4,/1PSI PER INC" OP PRODUCT TEST HEIGRT PRESSURE FOIORILA <br /> 1 16-Y <br /> H. PSI e. PSI NET PSI <br /> REMARKS: <br /> TI� L TEST PERIOD AS SHOWN ON THE ATTACHED COMPUTER GENERATED DATA REFLECTS A <br /> LOSS AIN F:,f0_ayGALLONS PER HOUR, WITH A 99% CONFIDENCE LEVEL OF +/- � r GPfi. <br /> HIE HORNER EZY CHEK II METHOD OF TESTING THE RESULTS AS SHOWN ARE WITTIIPP / <br /> NOT WITHIN TILE STATE OF CALIFORNIA 329 GUIDELINES OF IMUM LOSS OR <br /> .OS GALLONS PER HOUR FO A TANK SY ,STE0 BE CONSIDERS TIGHT. <br /> INTEGRITY TANK TESTING SYSTEMS, INC. 166 FRANK WEST CR. <br /> STOCKTON, CA 95206 46(�-$0�i or (800) 262-8378CERTIFIED TESTER TEST DATE <br />