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WORKSHEET FOR SUBMITTAL TO GOVERNMENTAL AGENCY <br /> DATE STORAGE FILLED TIME STORAGE FILLED PRODUCT LEVEL 8 ARRIVAL PRODUCT <br />_ _ _ tel, laioo0 Qin <br /> _ TANK CAPACITY yp- T3rouC AMOUNT OF PRODUCT ADDED TO FLOOD SYSTEM TANK LOCATION <br /> LIQ'..CALIBRATION. ',UP OF FP TO STM OF '-Nr '��' 2 <br /> LINES ___ TOP OF FP TO TOP OF INZ —� - -~• z <br /> I <br /> 10VEM.°LT -- MOF A7MR PRESENT PRE"S'T GR1VI':'Y _P _F, GRAVT:f ! 6OF ZOE ZTAN i.lP • �D ZW <br /> AVERAWS WATER PRESENT POSTEST <br /> INOM ATT TEST' STAlff" GRAVITY _ 8 F, GRAI^.TY t 60F C)E Z $ 6 O <br /> CAL QUAN :LINES =S.A INCHES Aa: :-ST END TAN :i,P CON 6 7 <br /> L4: <br /> • Dl LZ:EL LEV._LGAIN. + TIMES L"LCF._IL TKR_ 17-M�P T:::P G2IY + TII:ES Ta9R C0:'!B 2?"1P i_Sdl- <br /> T_'!E S-TART- END LOSS G8P =9 R£S^vI.'.^ 3r S'"AR" E"n LOce C.Ln= -n orcr•* orrn - .R=Si-r"'* <br /> C V .�g 1 F3 7 1 -e- 15,y I �' 6'l oo /6(P <br /> ('p�J �u ,00/3 iD0/o/ I; Y6� I oc I I :63` P�c36Y ,00h <br /> $s37 17oo1 1, W'lI�ocS IODDS <br /> �Ql g g I*c7- 116066 2 YG� I .�6 Iroc/ 13 63 Iroc (- <br /> s60��� 9 16 1 70 I t L 13,632 Ifioo96 I , ooJ6`/ , oo y9 <br /> �— <br /> cn <br /> � <br /> 77, )l � / I f,3,j1 1 I,o6Y6 1I.as I,gs� I two/ Is,7691taos4�l �oSylol X00$ 7l <br /> -120 t76 I -fl' 'i:5 6o 5,1 -e- I <br /> I. <br /> >bys Qgl I ga Imo/ I I too 2 170 I.Y7/ I ecl 13,63/�Iroo16Y <br /> I� - ?. I `�9F 18iy Ifool I.SrHGYI?ooSN6Il06gI <br /> • �Gh S / 00�� ] 9- 1 t,61 co <br /> 13.63 I? 36Yl �0677�' <br /> �- <br /> i a <br /> 7o36Y o036`/ <br /> I �0 0 ! 13,G3 y I ;oo36Y <br /> THE FINAL HOUR OFy <br /> OWNER/OPERATOR TESTING REFLECTS A LOSS / GA-177 OF: <br /> SITE ADDRESS ,=7- 9 73 pi USING IID: HORNER -c2Y CHEK METHOD OF PRECSION :ES-,LNG THE RESULTS: <br /> AF-E W 7, / AFLF LVOT W_=Z THE STATE OF CALIFORNIA AND THE NFPA <br /> MAILING ADDRESS- [/�---- 329 GUIDELINES OF A MAXIMUM LOSS OF .05 GALLONS PER ONE HOUR OF <br /> CIT?' ; TESTING FOR A TANK SYSTEM i0 BE CONSIDERED TIGER'. <br /> INTEGRITI' TANK TESTING SYSTEMS, INC 166 FRANK WEST CIRCLE <br /> COUNTY STOCKTON, CA. 95206 209) d 6 8036 (800) 262-8378 / p/ <br /> TELEPHONE (� CERTIFIED TESTcR,�C/^K/�c L TEST DATE <br /> AGENT <br /> y - GLS/8S <br />