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WORKSHEET OR SUBMITTAL TO GOVERNMENTALl4� Y <br />(ri?FtER/OPERATOR Z-e1V/'S'T�fS SITE ADDRESS 75 e. <br />CITY %' C3/ <br />HAILING ADDRESS �� ���i ��� ��lT 'e')C3 <br />�� p <br />SITE AGMt %/M TELEPHONE <br />ARRIVED TEST 51307/51IMM �TAAN�K LOCATION �i�� /����/�' rRODnC7 ,(J/[�C-�"� <br />DATE/TINE STORAGE FILLED S GI /*DUCT LEVEL AT ARRIVAL TNCNES BELM TOP OF FILL NOMINAL TANK SIZE �L�C7CJ <br />TANK MATERIAL �y -7 AFPROA. TANK AGE�RS. FILLSIZF/FIFE 7 UVERFILL CONTAINMENT TIFF. <br />AFI CRAVITi3i } d AT d bEC. F, - APi GRAVITY OFN,/ 1 60F - coFTFICIENT OF EXPANSION OF .O0O m f,S - COE _4 ,+5",2 <br />VISABLE VENTING AFFREARS To BE AT! FILL M<EFOSITE END, HAS BURP TUBE, HAS BALL CHECK, Iimiml , OTn" <br />VISABLE VAPOR ITLkrS TD BE BLEU: BALL CHECK -4, MANWAIS, RETURN LINES, OTHER <br />PRASE II VAPOR RECOVERY 9TSTEH! BALANCED, ASPIRATOR ASSISTED, LONG RUN WELLS, IMIFOLDED. OIr . tlTHER <br />PUrfpING SYS UCTr , TURBrHE MAKE , ____MODEL Z FIFE LINE. LFJIK Detectors YES, NO=TA CHARTED SIZE !Z/ZO EST. LINE QUANTITT /1rRODUCT ADDF,U TD FLOOD STSTP" .S SYSTEM TORAL CALLONAGE <br />MMIErrT CONDITIONS! TFHP! FRETESll�ls POSTEST 7© UT CLOUDY, RAINING. WINDY, BREF,2T, NIGHT, OTHER <br />.4 FSI DRIDWROURS TEST IO STAR/V0.';JfOURS FSI TO BE MAINTAINED OII TANK BOTTOM DURING TEST PERIOD - PSI <br />WA <br />R} MARKS : <br />RESULTS <br />R. GRADF, TO TANK IOTTLIN <br />1. CRAM TO TANK TOP <br />C. TANK DIAVMR <br />D. MT LI!VEL AEOVE GRADE <br />47 <br />�4 <br />E. tXTERNAL CRDUNO WATER ABOVE TANK <br />ROrt(m 1N. x .0361 PSI <br />F. TOP OF FILL TO PO00. AT ARRIVAL <br />G. TOP OF FILL TO TOP OF TANK <br />H. TUT::1IM'701OTTON OF TANK 9 <br />PSI PER INCH OF PRODUCTor <br />- <br />TEST NEIOff PRESSURE FORMULA <br />H. PSI E. psi HEr VS1 <br />ilE FINAL 'GEST PERIOD AS S11OWN ON THE ATTACHED COP#CUTER GENERATED DATA RFF1.ECTS A <br />OS / GAIN OF: i j GALLONS PER HOUR, WITH A 99% CONFIDENCE LEVEL OF +/- -OOZ, pph, <br />THE HORNER EZY-`CHEK II T1IOD COMPLIES WITH EPA AND THE STATE OF CALIFORNIA PERFORMANCE STANDARD OF 0.05 CFH <br />FOR TANK INTEL TING.CTION 2643 CALIFORNIA CODE OF REGULATIONS) BASED UPON THIS STANDARD, THE RESULTS <br />SHOWN ABOVE: DOES N INDICATE AN UNAUTHORIZED RELEASE EQUAL TO OR GREATER THAN THE 0.05 GPH STANDARD. <br />INTEGRITY TANK TESTN VICES, 41 WEST YOKUTS ST. STOCKTON, CA., 952/0)7, (209) 474-1375 or (800) 2�2--(8 & <br />CERTIFIED TESTER STATE LICENSE I♦_ "�V TEST DATE NT/ <br />