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33247Rb.l5s AN_- - AN ENVIRONMENTA�L CO. <br /> IVANHOE,CA 93235: PHONE (209)798-1856 <br /> AINLAY TANK `TEGRITY TESTER' FIELD TEST DATA <br /> 1 NAME ADDRESS PHONE <br /> i TANK �CnZQi � v_ Car a� <br /> OPERATOR <br /> ST c c+5-2�i <br /> I 2 IDENTIFICATION CAPACITY—GALS. MANUFACTURER STEEUFIBRGLS, AGE—YRS. <br /> TANKSTOT _54 _ G .\0000' <br /> BE TESTED 1D -S t L l D 00D ��six 14`1 <br /> 3 WATER <br /> DISTANCE FROM GRADE TO WATER I INS. <br /> TABLE <br /> 4 TANK WILL BE FILLED'? WH l (TIME)ON <br /> TANK EXTRA 5 GALS PRODUCT AVAILABLE FROM S \t <br /> FILL-UP FILL UP TO BE ARRANGED BY?OR. PHONE( ) <br /> CONTACT AT STORAGE TERMINAL IS MR. PHONE( ) <br /> 5 NAME ADDRESS PHONE <br /> OUTSIDE <br /> CONTRACTORS <br /> I 6 NAME AUTHORITY PHONE <br /> r OFFICIALS <br /> TO BE <br /> j CONTACTED <br /> II 7 <br /> i SPECIAL <br /> NOTES OR <br /> PRECAUTIONS <br /> 6 - ALL TESTS WERE PERFORMED IN ACCORDANCE WITH PROCEDURES DESCRIBED IN SOILTEST'S <br /> INSTRUCTION BOOK. CRITERIA FOR TIGHTNESS IS ESTABLISHED BY NATIONAL FIRE PROTECTION <br /> ASSOCIATION BULLETIN. N.F.P.A. 329. <br /> ( TANK IS TANK IS LEAK RATE TEST DATE <br /> 1 TEST TANK(DENT TIGHT NOT TIGHT G P.H. <br /> RESULTS S - OS v1 � �f 'LL u1\ <br /> O <br /> c, � <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 ON THIS DATE TO THE BEST OF MY KNOWLEDGE- <br /> EVE YOUNG CERTIFICATE NO. — <br /> $ CERTIFICATION SIGNED ISSUE DATE <br /> V <br /> e FOR(TEST COMPANY) <br /> m <br /> m ADDRESS <br /> m STATE ZIP <br /> N <br />