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WORKSHEET FOR SUBMITTAL TO GOVERNMENTAL AGENCY <br />NAILING ADDRESS /moi � , /. 0/0 <br />SITE ACRRT I(A114- `j/Q�Q��/!/I — J��.f�� � TELEPHONE `�-76�)_ gp p- zpd a. <br />ARRIVED TEST 8I10&�NOURS TANK LOCATIOR AF C E �z G~` TRMRIOC7y/L. p <br />DATE/TINE STORAGE FILLEDns / ROOUCT LEVEL AT ARRIVALtpL71E5 BElA1N TOT OF FILL NOMINAL TANK BT2E ''JJ�� __ <br />YANK MATERIAL// APPROX. TANK AGerTTRS. rILL3IZE/TTPE_�OVERFILL CONTAINMENT TTIF. /Y+/��� <br />Arl CRAVITTs4'/AT 6S DEG. F. - AFI CRAVITT Or�S,S! 6OF - <br />COEFFICIENT OF QPAH91oH OF ,000 /`p O <br />Irl/ z COE �ps9 <br />VISAALE VENTING APPREARS TO RE ATI FILL END, ILL OTOSITE ENII, RAS BURP TUBE, HAS PALL CHECK, <br />UNKNOWN OTHER <br />VISABLE VAPOR ]RAPS TO ME BLED: BALL CHECKS, HANWATS, RETURN LINES, OTHER !� <br />PHASE II VAPOR RECOVERY "STEM, CEI, ASPIRATOR ASSISTED, LONG RIAs WAT.I.S, MAKIFOLDEI, MORE, DIRER <br />PORTING SYSTEM CTIOM TURBINE MARE/��- <br />yy �b/t y-7 CC '�-""� / / MODEL 1%�PtPE=LINE LEAK Detectors TRS, NOp;T ATPLi <br />CHARTED SIZE p IPO EST. LIKE QOANTITT ///->> PRODUCT ADDED TO FLOOD 9YSTEI.J SYSTEM TONAL CALLONAGE <br />AHRIENT CONDITTMyONS: TET, rRETEBT-1 POSTEST4: - Mnm CLOUDY RAINING, WINDDT, BREE7,T, STORY, OTHER /J <br />.4 PSI DROA HOURS TEST TO STARRVl -' ROOALR FBI TD BE HAtNTAIMED ON TANK BOTTOM DOMINO TEST PERIOD T• / ISM <br />F--" _ R. CRANI. TO TANK BOITM /Z4AZ- <br />C�- <br />RESULTS <br />B. GRADE TO TANK TOP <br />C. TANK DIAMETER <br />00/z <br />I. TEST LEVEL AROVI "ADS <br />E. 2411NAL CWVH0 MATIR AROVI TANK <br />BORM M. T .0761 PSI . <br />I. TOP OF FILL TO PR®. AT ARRIVAL <br />3 <br />0. TOP OF PILL TO TOP OF TARK <br />as <br />N. TLTT'LBm To ROrrOR OF TANK <br />PSF "A INCH or PRODUCT <br />K .0*/ . __0__ <br />Psi F. r51 <br />HE FINAL TEST PERIOD AS SHOWN ON THE ATTACHED COMPUTER GENERATED DATA REFI.EC'IS A <br />,O / GAIN OFR --LO/'GALLONS PER HOUR, WITH A 99% CONFIDENCE LEVEL OF +/- .4; gpl,, <br />THE HORNER EZY CHER It TEST METHOD COOTLIF,S WITH EPA AND THE STATE OF CALIFORNIA PERFORMANCE STANDARD OF 0.05 GIN <br />FOR TANK INTEGRITY TESTING. (SECTION 2643 CALIFORNIA CONE OF REGULATIONS) BASED UPON THIS STANDARD, THE RESULTS <br />SHOWN ABOVE: OW DOES NOT INDICATE AN UNAUTHORIZED RELEASE EQUAL TO OR GREATER THAN THE 0.05 GPH STANDARD. <br />INTEGRITY TANK TESTING �yR�VTCCRSS,, _ 166 FRANK WEST CIRCLE, STOCKTON, CA., 95206, (209) 466-8036 or (800 p262 8318 <br />CERTIFIED TESTERi cyy _P' ,I-+�' STATE LICENSE 0 iy-lO" TEST DATE S �O <br />