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Data Chart for Tank System TigIness Test 1 <br /> (PLEASE PRINT - '. `' �,'•" r _r"r` TANK TESTER - A <br /> 1. OWNER. PropertySroc, <br /> Addrwe .. artpe.wubw Telephone . <br /> • N.rM wODr.n R.pnwrtaM TM.Mons <br /> 2. OPERATOR _^ <br /> tNalry ADonY TWpnOM <br /> 3. REASON FOR *; <br /> TEST <br /> (Explain Fully) <br /> 4. WHO REQUESTED ' <br /> TEST AND WHEN mme._- . - Tina CDnte.n.or Allies. <br /> - Admaa. - TN.DRJDY <br /> 5. WHO IS PAYING <br /> -. <br /> FOR THIS TESTI., CernD.n1.Avencr or lrrGvrdWl. - Parson ADnoianm Than T.Mmnsi <br /> lLD <br /> NNna"it. ., :- Gry -. .. Sod ._ <br /> - Anent.or:- a..,No. Omer IMnucbmw <br /> Identify by Direction Capacity Bond/Supplier d Gra - Approc Aye S1«vFiberylaa. '. <br /> 6. TANK(S) INVOLVED 2 to Be4r0, Ro u6., O <br /> #.a..., ILI 006 E4 N/ <br /> :.> sass.- JOGkh one-0, ry plydi" <br /> Location Cover. Fills Vents SidtoMs Pumps .. <br /> 7. INSTALLATION CoN(vr� IfnSbYoPTkbr L Fr 1 nC�siO�t: <br /> DATA: iui',�s�N[f; (:etno�rd NQ, <br /> Norm IMbrwaw <br /> a i .y r Iehl,luck Too Sita.TltNllr make DI.D _ S Csah."..w'as,el ins ien,alta Firm,etc lup f Ramon F.H. Sita.M.nitoicad whish?.."? A4Y it trwrn <br /> a. UNDERGROUND _i,. - .. is the waw over the unit? -<: <br /> WATER Depth to the Water table _ 0 Yea No <br /> - Tanks to be filled hr. Date Arranged by <br /> 9. FILL-UP N.m. T«aDMn. <br /> ARRANGEMENTS Extra Product to"top air"and run TSTT. Now and who to proylde? Comlder NO Le.d. - - <br /> Terminal or other contact 1 <br /> for notice a inquiry <br /> comoanr mma i ...... <br /> 10. CONTRACTOR. <br /> - MECHANICS, <br /> any other c intraQdr <br /> invdved . . <br /> 11. OTHER <br /> INFORMATION <br /> OR REMARKS .' <br /> Additional mtormation on arty isms above.Officials or others to ve advised when testing is in propreea at completed.visitors or citn era Present <br /> during test eta <br /> TMs slash,mads on the stove bank systems in accordance with test pmcWum prescNted for Fv!L <• <br /> 12- TEST RESULTS e_debaad con aCJchedr feast Chart$with h,sutba as follows: <br /> Tank Identification Tght Leakage Indicated Dm Tested <br /> -T/_)1p1-1' 0 G G. 111 )3-8(0 <br /> OG H, <br /> h . 013 G <br /> This is to fee t that thew tank systema wen tested on the date(s)shown.Tho es Indlcelad ase••TlyhV meet the Criteria eabablba and by <br /> 13. CERTIFICATION the wdonal Fire Proudtlon Asotiatldrl Pamphlet 729. <br /> S�ln-✓G �1/�/�//L�6 bra rsvi¢�✓ iSr°< <br /> D.n � i round Cfon//vector or Com car. Br: SOMINa �/ <br /> Sa No a Thermal t.cnrucyn. — /.dn,w. <br /> Sensor <br />