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v <br />AINLAY TANKOFGRITY TFSTFR'" FIFI n T&T nnrn <br />NAME <br />TANK <br />OPERATOR 3` <br />TANKS TO <br />BE TESTED <br />ADDRESS <br />c <br />IDENTIFICATION I CAPACITY -GALS. I MANUFACTURER <br />PHONE <br />STEELIFIBRGLS. AGE --YRS. <br />r <br />a WATER DISTANCE FROM GRADE TO WATER ' f INS. <br />TABLE <br />4 TANK WILL'BE FILLED Q_ (TIME) ON <br />TANK EXTRA 5 GALS PRODUCT AVAILABLE FROM �•� *►"�t a h ____ _ <br />FiLL•UP FILL UP TO BE ARRANGED BY MR. PHONE 4;Zo,?) a?2 " 74 o o <br />CONTACT AT STORAGE TERMINAL IS MR. F+ rif d_ PHONE ( Il <br />NAME <br />OUTSIDE 1Vo n <br />CONTRACTORS <br />8 <br />OFFICIALS <br />TO BE <br />CONTACTED <br />7 <br />SPECIAL <br />NOTES OR <br />PRECAUTIONS <br />8 <br />TEST <br />RESULTS <br />9 <br />NAME <br />ADDRESS <br />AUTHORITY <br />PHONE <br />PHONE <br />FEB 5 j. <br />PERMIT/SERVICES <br />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 />TANK IDENT <br />TANK IS <br />TIGHT <br />TANK IS <br />NOT TIGHT <br />LEAK RATE <br />G. P. H. <br />TEST DATE <br />CA- { e <br />-nodi ,3 <br />i -.z y- 9; <br />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 DATE TO THE BEST OF MY KNOWLEDGE. <br />CERTIFICATE N0. <br />CERTIFICATION SIGNED ti / ISSUE DATE 11954 <br />FOR (TEST COMPANY) <br />ADDRESS p I n x -3 3 q3 <br />�1iodtsfo �,{• 95353 — 6-Ni2- ?Gao <br />STATE ZIP <br />