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■I 1 1 1 1 1 1 soiLTtS <br />AINLAY TANK�EGRITY TESTER'' 'FIELD TO' DATA <br />PHONE <br />NAME ADDRESS . <br />i <br />TANK <br />ra <br />OPERATOR <br />�'"R AGE—YRS. <br />IDENTIFICATION CAPACITY -GALS. MANUFACTURER ST€ELf FIBRGLS. <br />2 <br />s tit L r D <br />TANKS TO <br />C w e / b° o <br />BE TESTED <br />FROM GRADE TO WATER INS. <br />3 <br />WATER <br />DISTANCE <br />TABLE <br />4 <br />TANK WILL -13E FILLED =0 (TIME) ON/ <br />TAWK <br />EXTRA 5 GALS PRODUCT AVAILABLE FROM if -4 ry f` h 4 , <br />PHONE 4�M g3�, _ 7,; o v <br />•- cin f 1.�3 <br />FILL UP TO BE ARRANGED BY MR. -., <br />FILL-UP <br />CONTACT AT STORAGE TERMINAL IS MR. - -PHONE( 1 <br />5 <br />NAME ADDRESS PHONE <br />OUTSIDE <br />/✓o �+ <br />CONTRACTORS <br />6 <br />NAME AUTHORITY PHONE <br />OFFICIALS <br />4 h <br />TO BE <br />CONTACTED <br />T <br />SPECIAL <br />NOTES OR <br />PRECAUTIONS <br />8 <br />ALL TESTS WERE PERFORMED IN ACCORDANCE WITH PROCEDURES DESCRIBED IN SOILTEST'S <br />ESTABLISHED BY NATIONAL FIRE PROTECTION <br />INSTRUCTION BOOK. CRITERIA FOR TIGHTNESS IS <br />ASSOCIATION BULLETIN. N.F.P-A. 329, <br />TANK (DENT <br />TANK IS <br />TIGHT <br />TANK IS <br />NOT TIGHT <br />LEAK RATE <br />G. P. H. <br />TEST DATE <br />TEST <br />d t?7t <br />/ _ -� y_ 91 <br />RESULTS <br />u r <br />coo ?Y64, <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 />90- <br />0-CERTIFICATION <br />'rte CERTIFICATE NO. <br />CERTIFICATION <br />SIGNED' ISSUE DATE / Ti <br />t <br />FOR (TEST COMPANY) <br />R <br />ADDRESS • Q'gqza _ <br />(74. 95353 <br />STATE ZIP <br />a <br />