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33247 RD.ties - WAN ., NVIRONMENTAL O. <br /> IVANHOE, CA 93235' -_ PHONE (209) 798-1856 <br /> AlNLAY TANK `TEGRITY TESTER" FIELD TEST DATA <br /> 1 NAME ADDRESS PHONE <br /> f <br /> TANK <br /> i OPERATOR <br /> 2 IDENTIFICATION CAPACITY-GALS. MANUFACTURER STEEL/FIBRGLS. AGE-YRS. <br /> j I ' IDo T, <br /> TANKS TO <br /> BE TESTED t <br /> 3 WATER <br /> TABLE DISTANCE FROM GRADE TO WATER t '-3 INS: <br /> 4 TANK WILL BE FILLED `^ (TIME) ON I l /-Lx- <br /> TANK <br /> zLTANK EXTRA 5 GALS PRODUCT AVAILABLE FROM <br /> FILL-UP FILL UP TO BE ARRANGED BYIOR. PHONE 1 <br /> CONTACT AT STORAGETERMINAOL IS MR. PHONE( ) <br /> 5 NAME ADDRESS PHONE <br /> OUTSIDE <br /> CONTRACTORS <br /> 6 NAME AUTHORITY PHONE <br /> OFFICIALS <br /> TO BE R- <br /> r <br /> CONTACTED <br /> 7 <br /> SPECIAL <br /> NOTES OR <br /> PRECAUTIONS <br /> 8 - ALL TESTS WERE PERFORMED IN ACCORDANCE WITH PROCEDURES DESCRIBED IN SOILTEST'S <br /> ti INSTRUCTION BOOK. CRITERIA FOR TIGHTNESS IS ESTABLISHED BY NATIONAL FIRE PROTECTION <br /> ASSOCIATION BULLETIN. N.F.P.A.329. <br /> TANK IDENT TANK IS TANK IS LEAK RATE TEST DATE <br /> TEST TIGHT NOT TIGHT G.P.H. <br /> RESULTS T�_ _pZ -� p\\'1 — -t • a <br /> j <br /> t <br /> 9 THIS CERTIFIES THAT THE TANKS DESCRIBED WERE TESTED BY THE UNDERSIGNED AND THAT THE STATED <br /> RESULTS REPRESENT THE TRUE STATE OF THE TANKS <br /> � O(N`�THIS DATE TO THE BEST OF MY KNOWLEDGE <br /> y�� <br /> CERTIFICATE NO. <br /> CERTIFICATION SIGNED �^^- S1Ev 991).As ISSUE DATE <br /> i w <br /> FOR(TEST COMPANY) <br /> ADDRESS <br /> r STATE ZIP <br /> N <br />