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Data Chart for Tank System TightnYss Test Be <br /> petro TitP <br /> TANK TESTER <br /> 1. OWNER Property :5441'TAQk/ CiT/ �1gPdS/4� 369-/8z,4 <br /> Tanks) <br /> —/ Net 1333 —itn -RPAddress 4DR C�1. Telephone <br /> �a�' Y fi -- ----- --- -- <br /> Name Address Telephone <br /> 2. OPERATOR SAptE) -- <br /> Name Address _ Telephone <br /> 3. REASON FOR TEST AM404 "&D0IQE»1EWr 1i Lk� 11 <br /> (Explain Fully) <br /> It- <br /> 4. WHO REQUESTED <br /> TEST AND WHEN Name T GaF?RFh�?f.�n1V3V4p. ,-,LTH Date <br /> �-nn nl- �ccnVII�FC <br /> Address Telephone <br /> 5. WHO IS PAYING SRNYAC✓ Cr'7( <br /> FOR THIS TEST? company,Agency or ndividual Person Authorizing Title Telephone <br /> Billing Address City State Zip <br /> Attention of: Order No. Other Instructions <br /> 6. TANK(S) INVOLVED Identify by Direction Capacity Grade Approx.Age Steel/Fiberglass <br /> ►i&(y —74pie 6G06 4Z DIESFI ? Sly AI/ <br /> 7. INSTALLATION Location Cover Pills Vents Siphons Pumps <br /> DATA Aj Yqw Cnaezr� ,3h Za AbWE. swriaJ <br /> Nonn msde crneway. Concrete.Black Top. Size.Ttlelill make.Drop Suction.Repels, <br /> Rear of slalwn.etc Earth etc. tubes.Remote Fills Size.Mamlolcec Which larks? Make d known <br /> 8. UNDERGROUND Is the water over the Iaank7 <br /> WATER Depth to water table if known ElYesCI No <br /> 9. FILL-UP IAIt <br /> ARRANGEMENTS Tankstobafilled Date Arranged by 'T.110101 <br /> Telephone <br /> Hour <br /> 10. TECHNICIANS !J __7-"7,a4lilro D <br /> 11. OTHER 043 .4//ow,od/E rz✓�P,r�� <br /> INFOliMAIION c.P 050462 rS 007 ' rkhli9 TAAW -7ZWrdE Al C:rd 60'T <br /> OR REMARKS $#&V -7b BE W -PWrbe Alit -04F si GA&Aec Me AApy,* QA7y &1 2086 <br /> Additional information on any items above.Officials or others to be advised when testing is in progress or completed.Visitors or observers present <br /> during test,etc. <br /> 12. TEST RESULTS Tests were made on the above tank systems in accordance with lest procsdures prescribed for Petro Tde <br /> as details on attached test charts with results as follows: 1p5TI <br /> Tank Identification Tight Within Tolerance Out of Tolerance Dale Tested <br /> nlOM7MINA yES _._ —.o43 - <br /> 4Z Z)1i <br /> 13. CERTIFICATION This Is to certlfy that these tank systems were tested on the date(s)shown.Those Indicated as"Tight"meet the criteria established by the National Fire <br /> Protection Association Pamphlet M. <br /> —lO Qn Name of person certifying <br /> Delo C•i., ��QAr/� A.%aQA� .,�iWt—�OQf�E <br /> I Con 02012 �o41d813145 _ 361 d. r �: 1 rCp By: Bi 95?r10 -- <br /> Serial No.of Thermal Sensor Certifcation Number Address <br />