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e axmylnt W ami' <br /> NOV 9 1989 <br /> Data Chart for Tank System Tightness Test ENVIRONMENTAL HEALTH <br /> PP$ro nt—ch PERMIT/SERVICES <br /> TANK TESTER 6 7 <br /> PLEASE PRINT / <br /> r r(�H /yIr Eipr 2o9-Y7`-909< <br /> 1. OWNER Property GF I T. qp ears. uu.. <br /> AOUOfa 7i -n7J <br /> Name �Z V G <br /> hnk(e) Reonwntath'. Ttl.pnpn. <br /> Nem. wddm.. <br /> 2. OPERATOR N.m. Address T.I.Phon. <br /> 3. REASON FOR <br /> TEST <br /> (Explain Fully) --- G <br /> 4. WHO REQUESTED Nemm <br /> . Till. Comwny o,AlllliWon Dau <br /> TEST AND WHEN er.onon. <br /> Address <br /> 5. WHO IS PAYING Company.Agency el Individual PaDon Autnodclns Tide T.leonon. <br /> FOR THIS TESTS <br /> Billing weewu City Suu Zle <br /> AB.nllon et: Older No. Other Instructions <br /> Identify by Direction Capacity Brand/Supplier Grade Approx.Age Steel/Fibsglsss <br /> 6, TANK(S) INVOLVED <br /> eco '-Cit k <br /> Location Cover Fills Vents Siphones Pumps <br /> 7. <br /> ,{ <br /> 7. INSTALLATION E"o.5t 0_�_ y / <br /> DATA 1vi,yf.`so._i <br /> Norah Inside driveway. concert.Black Too. Sire,Tiulill mase.DwoSunianRemote. <br /> Real of ttallon,at[. Eann,eis. iticks.aemole Fills Sire.M.niloldad Which ranks <br /> 1 Make n\nown <br /> 8. UNDERGROUND T 1s the wilt.,over(Ih'�a�tens/ <br /> WATER Deplh to the Water table /GI rT .i 1:1 yes. IIQ "- <br /> Tanks to be filled hr. Dale Arranged by <br /> 9. FILL-UP Name T.I.pno.. <br /> ARRANGEMENTS Extra product to"top off'and run TSTT. How and who to provide l Carries,NO Lead. <br /> Terminal or other contact <br /> for notice or inquiry <br /> company Name T.Hpnone <br /> 10. CONTRACTOR, — <br /> MECHANICS, <br /> any other contractor <br /> involved <br /> 11. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> Additional information an any items above.Officials or others to be advised when testing is in progress or completed.Visitors or observers present <br /> during test to. <br /> Tests were made on the above tank systems in accordance with test procedures prescribed for PPirO <br /> 12. TEST RESULTS as detailed on attached test charts with results as follows: Mr?TI}P <br /> Tank Identification Tight Leakage Indicated Date Tested _ <br /> Gr I <br /> 13. CERTIFICATION Thla is to certify that these tank systems were tested on the date(s)shown.Those Indicated as"Tight'meet the criteria established by <br /> the National Fire Protection Asociation Pamphlet 329. <br /> Lawrence Tank Testing <br /> Dila <br /> Sergi No.of Thermal P.O. Box 407 er: Sigmmu <br /> Downieville,California 95936 (916) 289-3109 <br /> chmciana <br /> Sensor <br />