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�-' *480( <br /> WORKSHEET FOR SUBMITTAL TO GOVERNMENTAL AGENCY <br /> OIVNER/ '-.-- 7` ` SITE ADDRESS .2.aE � <br /> CITY .CTn I S_S 6C. COUNTY - <br /> MAILING AbDRESS'� <br /> SITE AGENT TELEPHONE <br /> ARRIVED TEST SITl6/7LTIOURs TANK LOCATION/MUMgR <br /> DATE/TIME STORAGE FILL! '� RODUCr LEVEL AT ARRIVA NICHES SE'LLGII TOP OF FILL. NOMINAL TANK SIZE <br /> TANK MATERIALPRO%. AGE Is PILL SIZE/TTPPII <br /> �L OVERFILL GONTAINI£NT[JTYPE <br /> S f! `7 <br /> MI GRAVIT116 W AT a DEG. F. • Mr GRAVITY OF'�S GOP • COEFFICIENT OF EXPANSION OF: .D0y0. (• CO! OFY— Sl- 2 <br /> VISMIE VENTING APPEARS TO BE : FILL END, [LL OPPOSITE IR tzlml HAS 11 S L Uig At '2%9;6&1 <br /> YISRRL! YAP011 TRAPS TU SB BLED: BALL CHECKS, NANWAYS, OIHER J/iP C��1.2QA�G/J '/" �A// \J <br /> PHASE 11 VAPOR•IBI�;TT SYSNRRMITYPE? e� RATO�I ASSISTED LONG RLN WELLS <br /> /-HANIFOLDED —a OTHER <br /> MODEL •'7 "�Y PIPE LIN! LEAK DETECTORS YdD <br /> CHARTED TANK SIZE�ESTIMATED LINE QUANTITYzRIDUCT ADDED TO FLOOD SYSTEM�YSTEM GALLONS TOTAL Za.3iT-Z• <br /> AMBIENT WEATHER CONDITIONS: TEMPERATURE PRETEST—POST TEST MINING CLOUDY WINDY NIGHT OTUE <br /> SYSTEM FLOODED Halls .1 PSI DROP Hours PSI TO BE MAINTAINED ON TANK SUTTON DURING TEST PERIOn �a" _ <br /> A. GRADE TO TANK BOTTOM <br /> B. GRADE TO TANK TOP <br /> C. TANK DIAMETER <br /> 677 OF <br /> .i D. TEST LEVEL ABOVE GRAVE <br /> ZTANI <br /> .yN3 / . .. <br /> B. EXTERNAL GROUND NATER MOVE TANK <br /> F BORON IM. K .0361 PSI <br /> - -,„J I� F. TOP OF FILL 7O PROD. AT ARRIVAL <br /> A /moi/ G. 70P OF FILL TO TOP OF TANK <br /> QJ>� N. TEST I.EVEL'TO BOTTOM OR TANK <br /> Ci---� PSI P!R INCH OP PR)OULT <br /> TEST HEIGIrr PRESSURE FORMULA <br /> K = <br /> I� E Y/L N. PSI e. PSI xgr rsi <br /> REMARKS: � , <br /> T <br /> TINE FINAL TEST PERIOD AS SHOWN ON TINE ATTACHED COMPUTER GENERATED DATA REFLECTS A <br /> LOSS / CAIN OF: GALLONS PER HOUR, WITH A 99% CONFIDENCE LEVEL OF •/_ CPU. <br /> USING THE TIORNER EZY CHEK II METHOD OF TESTING TILE RESULTS AS SHOWN ARE WITYIN / <br /> NOT WITHIN TILE STATE OF CALIFORNIA AND TILE NFPA 329 GUIDELINES OF A MAXIMUM LOSS OR <br /> GAIN OF .OS GALLONS PER HOUR FQR A TANK SYSTEM TO BE CONSIDERED TIGHT. <br /> INTEGRITY TANK TESTING SYSTEMS, C. 166 FRANK WEST CR. <br /> STOCKTON, CA 95206 S]d�466 3 or (800) 262-83.778 <br /> CERTIFIED TESTER4`r` ST DATE-75//--0 <br />