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t <br /> DATA GHARTµFOR TANK <br /> y�S�Y,sTr:m,TIGHTNESS TEST <br /> CCIS? tut T ums <br /> ""=R&lU 30057 <br /> 1-SWO Dt[,G !3213 <br /> CLIENT (204J 93man I <br /> NAME OF SUPPLIER, --' -- - — - <br /> OWNER OR DEALER DATE OF TES TTMr-START' TIME FINISH LENGTH OF TEST <br /> ADDRESS(NO.d S7-RE277) WEATHER TEMPERATURE <br /> CITY AND'STATE <br /> TANK INFORMATION <br /> CAPACITY(NOMINAL)O� a GALS. SIZE OF FILL OR T'cj, OPENING / `t IN. CONTENTS(FRODUC )LIA ()LSI 7 <br /> CAPACITY(CHArFFM GALS. TOP OFF:TIME HOUR DATE <br /> GALLONS TANK MATEr�{[AL NE'�L Fr?r CL4�5{ ) <br /> DII4fyN51ON5: DG4ME--tiR NUMBER OF LLONS Ad C TOAs, i c�i APP'ROX.AGE <br /> LENGj-H TANK NO. PUMP SY$`cM-iYPE_3U9 MAKE <br /> INCHES OF WATER - BE FORE T_-57 -49- Ara'cR TEST SUCTION?_ ] - <br /> TEST CALIBRATION - Y' LEAK DETF-CTOR YES NO { ) <br /> TANK LAYOUT LEAK <br /> RECOV=ERY SYST=H YE 4z D!K NC( <br /> S�OF CAL SAP OR ML'S At^J07 .�1.�,f., _ <br /> �s.L•n� �sA.:,.,�ry PHASE I, M PHASE 2 W <br /> LINE MOVEMENT OVERSPILL CONTAINER YES(3)NO(a <br /> 1 4-7 t0 _ �I LINcS SHEAR VALVE YES( ) NO( ) <br /> Z- L�3 to 5L <br /> 3 <br /> ­7 to �/„ _ LINES' <br /> - LINES �n <br /> vTAL LINES-3 = — V LINES <br /> (xl.My <br /> "D OF TEST CALIBRATION <br /> SIc`.-_OF CAL SAP OR ML'S ADC7EO <br /> (ALM, IFA.—,vR Aj .. <br /> LINE MOVEMENT <br /> 1 tc `t - <br /> ZtoD aZ� LINES <br /> �� LINES <br /> 3 <br /> to / = T UNES <br /> TOTAL -74 LINES - 'a = _ ,le <br /> ONES <br /> (ALM) <br /> MEASURED API SPE'--:FTC GRAVI1! <br /> PROOUCT TEMPERATURE <br /> API SPECIFIC GRAVITY a Goo F (FROM TASLE A) <br /> COE.==IC:ENT OF EXPANSION -C 6 .0 �'q 7, (FROM TAaL a) <br /> A-3.7i-1 <br /> G <br /> Vi TOTAL aAPACITY(GAL] VOL CHANGrs"F(FACTOR 8) <br /> OWNER OF SITE ADDRESS <br /> CITY STATE Zip CODE <br /> OWNER OF TANK ADDRESS <br /> CITY STATE ZIP CODE <br /> COUNTY <br /> TECHNICIAN(S) DATE <br /> a _ <br />