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WORKSHEET FOR SUBMITTAL TO GOVERNMENTAL AGENCY <br /> 1 <br /> OWNER/0 RA R �eel <br /> SSIT'F ADDRF. S—� �I� __.-_/ - <br /> CITY ]OIIN`I'Y Gt - <br /> MAILING ADDRESS C' . <br /> SITE AGENT TELEPI ONE <br /> ARRIvED TEST SITE1? 6 LIOURS TANK LOCATIOH/HUMBER - <br /> / �} c� 5 �i <br /> DATE/TIME STORAGE FILLFTl •�/T_ PRODUCT 1SVEL AT ARRIVA[ „ "CHES BELOW TOP OF FILL MCR41HALL TANK SIZE nn <br /> // 2 J <br /> TANK MATERIAL. L1—_yLc APPROX. AC`E!� RS. FILL SIZE/TYPp .3 OVERFILL CONTAINMENT TYPE `7�r�•-�-t' <br /> API GRAVITY N r AT ;7? DEG. F. • API GRAVITY OP li 4 60F • COEFFICIENT OF EXPANSION OF: -Dtet^r l • COE OF-,— _F <br /> VISARLE VENTING APPEARS TO IF AT: FILL END, LL OPPOSITE EN -`HAS BURP TUBE, UNKNOWN, HAS A BALL CFLECK, ONIIER <br /> VISABLE VAPOR TRAPS TO ER BLED: WALL CIIECKS�. )MANWAYS, OTNER_- �^ _ <br /> M&SE 1I VAPOR RECO-VERY SYSTEM TYPE IALANCgfY AS J TOR A^*SISTBD LONG RUN WELLS MANIFOLDPO NONE OTIIE <br /> PUHPINC SYSTEM* <br /> SUCISON 1 TURBINE! HAKLFJI.JJ�7 MODEL PIPE LINE LEAK DETECTORS I <br /> CiNARTED Z ESTIHATEb LINE QUANTITY C7 PRODUCTDDED TO FLOOD SYSTEM O SYSTEM GALLONS TOTAL 7L <br /> AMBIENT WEATIIER CONDITIONS: TEMPERATURE PRETEST7,160ST TESUNNY RAINING CLOUDY WINDY NIGHT OTHER (/ <br /> �j��� <br /> SYSTEM FLOODED art HOURS .4 PSI DRONIJI�7 HDQRS PSI TO BE MAINTAINED ON TANK bull DURING TEST PERIOD S f <br /> A. GRANDE TO TANK BOTTOM <br /> B. GRAN TO TANK TOP <br /> C. TANK DIAVEYER <br /> 6ti'A.l7E �y <br /> �t �j D. TPST LEVEL ABOVE GRADE <br /> �• G fcf 12% B !. eKTERNAL c�RO ND WATER ABOVE TANK <br /> FI.L/ �I )(¢J �j � BOTTGM tH�. z .0361 PSI <br /> /SI f P. TOP OF FILL TO PROD. AT ARRIVAL <br /> G. TOP OF FILL TO TOP OF TANK <br /> 5✓ H. TW I.ZVEL TO BOTTOM OR TANK _LCL,�8 1/ <br /> WATER INS C PSI PER INCEI OF PRODUCT V L <br /> TANK a - TEST HEIG,ff PRESSURE FORMULA <br /> 86 l/ / <br /> H. PSI B. PSI NET PSI <br /> REMARKS : <br /> T11E FINAL VEST PERIOD AS SHOWN ON TINE A17ACIIED COMPUTER GENERATED DATA REFLECTS A <br /> LOSS / GAlN OF; GALLONS PER HOUR, WITIi A 99% CONFIDENCE LEVEL OF +/ GPIs. <br /> TIIE [iORNFR EZY CIIEK II METHOD OF TESTING THE RESULTS AS SHOWN WITrfIN f <br /> NOT 1-THIN I11F STATF. OF CALIFORNIA AND 'I'11E P 329 GUIDELINES OF A MAXIMUM-LOSS OR <br /> AN <br /> iv�Ul' .U5 GALLONS PER i10UR FQR TK SYSTgN TO BE CONS IDEREGlIT <br /> INTEGRITY TANK TESTING SYSTEMS, INC. 166 PRANK WEST CR. <br /> STOCKTON, CA 952Q5 (800) 262-8378Q� <br /> CERTIFIED TESTF f�,�.(�1-�-(� ST DATE �r �fJ � <br />