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WORKSHEET FOR SUBMITTAL TO GOVERNMENTAL AGENCY <br /> ayNERIOPERAIOR ���/� ��aG` Td'{� . 2�Q <br /> SITE ADDRESS / f'Y. � , it✓�ir-�j%d.�J' <br /> CITY S7-At' 7-Cli1 COVNTT J� <br /> MAILING ADDRESS :qe' <br /> SITE AGERI TEL>PHONE ) fj r L <br /> ARRIVPm T-EST SITC7za:� TAN�Ky}LOCATION lg'c�r �L>C'f� PRODOCT <br /> DATE/TIM STORAGE FILL AAo" ePRODUCT LEVEL AT ARkI4AL Za INCHES Ri XW Tor OF FILL N9HIHAL TANK SIZE /TO::� <br /> TANK MATERIAL APPROX. TANK ACI&JTnTRS. FILLSIZE/TTrE le OVERFILL CONTAINMEnj TTPE <br /> API GRAVITLYu'Z- AT DEC. F. - API GRAVITY OF 6OF - COEFFICIENT OF Exro5I0N or .00065yS'j:� - COE 6-5- <br /> VISARLC VENTING APPREARS TO BE AT, FILL FILL OPOSITE ETH1, NAS BURP TORE, RAS BALL CHECK, 0?1KNOSJN, OTH" <br /> VISABLE VAPOR TRAPS TO BE BLED: BALL CHECKS, MANWATS, RETURN LINES, OTHER <br /> PHASE II VAPOR RECOVERY STS BALANCED. ASPIRATOR ASSISTED, LCRG RUN WWmLL5, MANIFOLDED. FORE. OTHER <br /> P".rNG STSTIOi: SUCTION, TURRI HAKBHf?DEL <br /> FIDS LIFE LEAx Detect Oi 7T.5 HC1; NOT AFPLIC <br /> CHARTED SIZT/7--+702—") EST. LINES quARTITTAb FR�ODUCT AD FLOOD STST" � RTSTEM TORAL CALLONACE <br /> AMBIENT CONDITIONS: TEMPt PRETEST/-yrosiEST� tATDT, ININC. WINDY, BREFZT, NIGHT, OTHER <br /> .4 PSI 1)42 "--r ROM TEST TO STARJ�/04DROURS PSI TO zE MAI AINTD ON TANK BOTTOM DURING TEST rERIIOD / P3I <br /> .. A. GRADE TO TANK BOTTOM <br /> Q <br /> 8. CRAM TO TAI4K TOP /y7 <br /> C. TANK DIAMETER 77 <br /> Gl J1� <br /> 777,-T7-Zr- D, TEST LEVEL ABOVE GRAD! <br /> E. 1!riEWAL CWXW HATER ABOVE TAN[ <br /> IOTTCM IM, 1 .0361 PSI l . <br /> F. 'MP OF FILL TO PROD. AT ARRIVAL <br /> A 0. TOT OF PTLL TO TOP OF TANK �JZ/ <br /> C�A f1. 7Y+ST �7EL Ta tOTTOIf aP TWK <br /> HATER iHStIE 7 PSI PER I"m OF PIUMICT , <br /> TAKK ^ / TEST NEIGIT PRESSURE FUMJLA <br /> H. <br /> REI'lARKS PSI E. rsI NET rsl <br /> RESULTS <br /> HE FINAL TEST PERIOD AS SHOWN ON THE ATTAUED COHPUTER GENERATED DATA REFLECTS A <br /> LOS / GAIN OF:Z GALLONS PER HOUR, WTTTI A 99% CONFIDENCE LEVEL OF +/— ��� pph, <br /> THE MOANER EZY CHEK II7EOD COMPLIES WITH EPA AND THE STATE OF CALIFORNIA PERFORMANCE STANDARD OF 0.05 GPH <br /> FOP. TANK INTE T ION 2643 CALIFORNIA CODE OF REGULATIONS) BASED UPON THIS STANDARD, THE RESULTS <br /> SHOWN ABOVE: EICATE AN UNAUTHORIZED RELEASE EQUAL TO OR GREATER THAN THE 0.05 GPH STANDARD. <br /> INTEGRITY TANK TESTING S VICES, 41 WEST YOKUTS ST. STOCKTON. CA., 95207, (209) 474-1375 or (800)Q 62-83 9Y <br /> CERTIFIED IESIER ✓rC STATE LICENSE 0 f tq,, <br /> oTEST DATE U <br />