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AINLAY ANh EGRITY TESTER Tm FI D T DATA . <br /> NAME ADDRESS PHONE <br /> TANK /�9 9` /7? �fbrr o t 'v� �3:5--- 76)71 <br /> OPERATOR _D Eo /o <br /> c <br /> 2 IDENTIFICA I N CAPACITY-GALS. MANUFACTURER STEELIFIBRGLS. AGE-YRS. <br /> a- U h P LC K c <br /> TANKS TO <br /> BE TESTED <br /> WATER DISTANCE FROM GRADE TO WATER a O -4 INS. <br /> TABLE <br /> 4 TANK WILL BE FILLED y' O o(TIME) ON 1012 <br /> TANK EXTRA S GALS PRODUCT AVAILABLE FROM' 2D./7A TT. <br /> FILL-UP FILL UP TO BE ARRANGED BY MR. C • 4 , PHONE 74 00 <br /> CONTACT AT STORAGE TERMINAL IS MR. SCc/n c - PHONE( I <br /> 5 NAME ADDRESS PHONE <br /> OUTSIDE <br /> CONTRACTORS <br /> 8 NAME AUTHORITY PHONE <br /> OFFICIALS Soh Toad . Co hey <br /> TO BE <br /> CONTACTED <br /> 7 <br /> SPECIAL <br /> NOTES OR OCT 15 ";^";1 <br /> PRECAUTIONS ENVIRONMENTAL HEALTH <br /> P RN11T/ FRVlC-S <br /> w 8 ALL TESTS WERE PERFORMED IN ACCORDANCE WITH PROCEDURES DESCRIBED IN SOILTEST'S <br /> INSTRUCTION BOOK. CRITERIA FOR TIGHTNESS IS ESTABLISHED BY NATIONAL FIRE PROTECTION <br /> ASSOCIATION BULLETIN. N.F.P.A. 329. <br /> TEST TANK IDENt TTIUHT NOT TIGHT L G.P.H.RATE TEST DATE <br /> RESULTS.. h e / - 3 -. V/ <br /> J 9 THIS CERTIFIES THAT THE TANKS DESCRIBED WERE TESTED BY THE UNDERSIGNED AND THAT THE STATED <br /> RESULTS REPRESENT THE TRUE STATE OF THE TANKS ON THIS RATE TO THE BEST OF MY KNOWLEDGE. <br /> Ch <br /> �y CERTIFICATE NO. 9� -moo f// <br /> rr! CERTIFICATION SIGNED ISSUE DATE / 9 s 4 <br /> s FOR(TEST COMPANY) 66,p l,7e 7,,,6 Ate <br /> 'j ADDRESS P 0, Ro x 3 y�/ �? .. <br /> s �1od¢s7'�, . �a S3S3' _ 737- 7Goy <br /> k A t <br />