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Data C,t for Tank System Tight. ,,s Test <br /> petro Tite <br /> PLEASE PRINT TAPIX TESR31 <br /> 1. OWNER preparty <br /> Tank(Q ® name Aedl«a 7 YMve TMeMow <br /> Nsm• Adder RearewnlYNee `l <br /> l a <br /> 2. OPERATOR SAmgir <br /> Name Adorers <br /> 3. REASON FOR <br /> TEST <br /> (Explain Fully) 1{� <br /> 4. WHO REQUESTED eery S L <br /> TEST AND WHEN TO Q A EL ASE n°' i t S/ytJ hIAA!AGL'a y/f� 8 3 D 532 <br /> Adr•aa Telephone <br /> 5. WHO IS PAYING STOLZ <br /> FOR THIS TEST? C"""'" •ncr«Iraly vel wr.on AurnorYllq Thu• / Tetapho e <br /> e.amll Addr«s Gry - Stale Zip <br /> ANwtbn ol: ONer No. Omer Inaupcewls <br /> Identify by Direction Capacity Bread Supplier Grade Appmx.Aga Steel/Fibergler <br /> 6- TANK(S) INVOLVED <br /> 5 e <br /> !/ 1s V <br /> Location Cover FRIs Vents Siphores Pumps <br /> 7. INSTA <br /> DATA LLATION /I O P� j <br /> n <br /> ConCp�f e z /41114 Suci,lati <br /> NOnh mea.driwweY. Concrete.e"ck Too. lux.Tiunn mete,Drop suction,Remote. <br /> Rwr OI aYllon,alt. E•M..IC. fuses,Remote Fills sir..M.Mbided Which Ynks 1 Yak.it k.-. <br /> 8. UNOERGROUNO Is the water over the t 7 <br /> WATER Depth to the Water tads n <br /> EJ Yea No <br /> Tanks to be filled In. Data Ananged by <br /> 9. FILL-UP Nem. Tel.onpn. <br /> ARRANGEMENTS Extra product to"top 0""and run TSTT. Now and who to provide? Consider NO Lead. <br /> Terminal or other contact <br /> for notice or inquiry <br /> COmwny Name Taleph... <br /> 10. CONTRACTOR, 7T ' 1�iZCtAO►.?A{ K_u_ Le <br /> MECHANICS, <br /> any other contractor <br /> involved <br /> 11. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> Additional information on any hems above.Officials or others to be advised when tenting is in progress w completed.Visitor,w observers present <br /> during lest at.. <br /> TMs wan made on the above tank systema In accwdancs with last procedwsa proscribed ler pkellp IL}P <br /> 12. TEST RESULTS as 1501+11011 pre attached ro <br /> test charts with sutts as follows: 'MRS <br /> Ta^nk Identification Tight Leakage Indicated Date Tested/ P `�O1 9-- 020- <br /> f•,d Z <br /> Al) <br /> I a. 011 <br /> 13. CERTIFICATION tln wttponNsFln Protethat eae bealt S Yatlm,Pamphlet tested on the da*s)shcnw'Tlttra0 Indicated n"Tight"rrlsat the cdtaxis established by <br /> .mphlet 379. <br /> 42 c r-L5jY i 6 �,/y5srai6� 4Lw,4 / <br /> D <br /> -16 <br /> �q 0 /6 A� r«unp ConuacYr or rrs. 6.:- nm <br /> / s«tr No.a1 Thermal • T - �QO ]rrJkfn//A!(�l' r �S yfA1lUSCo .�. <br /> s. Addr«s <br />