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Y <br /> DA <br /> TA FOR TANK-SYSTEM TIGHTNESS TEST. <br /> }` 1 y 'CRISP Ywx <br /> A�i _ <br /> MET <br /> w .a. Y+<� -�_ y- <br /> r3 MOMI I - <br /> - - - <br /> CLl'F.NT 1"$48n I <br /> NAME OF SUPPLIER, <br /> OWNER OR DEALER DATE OF TEST -�? -"tr T <br /> ADDRESS(No.&ST_REET? TART' TlmF FINISH LENGTH OF TEST <br /> CITY AND'STUE WEATHER TEMPERATURE <br /> TANK INFORMATION _ <br /> CAPACITY(NOMINAL) GALS. Si2E OF FILL OR TEST OPENING - IN. CONTENTS(PRODUCT) Jf) ��^7 Nam- <br /> CAPACITY(CHART) _GALS, TOP OFF TIME HOUR DA7E c GALLONS M °E r, c <br /> DIM=NSIdNS: DIAhdE=A TANK MATERIAL METAL FI 4u,..d_S'(' ) .NUMBER OF GALLONS AODED TO SART TcSTry APPROX.AGE <br /> LEND H TANK NO. PUMP SYS eim-TYPE:-SUB( ) MAKE <br /> INC,*qES OF WATER - BEFORE T=ST AF`;ER TEST SUCTIoN <br /> TEST CALIBRATION LEAK, DET-cCTOR YES N0�(� <br /> Sim OF CAL BAR OR ML'S AOOE7 /�� _- TANK urauT VAPOR RECOVERY SYS7=0 YES(- ) NOCu) <br /> LINE MOVEMENT - (A;Jmi (FACMR A) PHASE 1 ( ) PHASE 2 ( ) <br /> OVERSPILL CONTAINER YES( )NO{\<j <br /> j 3 - LINES SHEAR VALVE YES( ) NO('<} <br /> 2 <br /> LINES <br /> LINES <br /> ICTALLINES 3 = .,3 LINES <br /> IALMu <br /> END OF TES­j CALIBRATION <br /> SIE OF CAL.BAR OR M'L•S ADO=:) <br /> UNE MCVr--ME.NT rALW (F-CMA a <br /> 151 to =± 7 =—^ U L NES <br /> 2 1 1 ` _ <br /> to ) LINES <br /> 77 to m = I-7 <br /> - LINES • <br /> TG TAL LINES -LIN S <br /> (ALM) <br /> MEASURED API SP=ECIFTC-;;AVY'Y S 7 <br /> PRODUCT TEMPERATURE ?i <br /> API SPccmc GRAVITY c 6D°F ­7' <br /> � FROM TABLE A) <br /> COEr=ICIENT OF EXPANSION 00 /7 <br /> (FnOM�BLP B) - <br /> to� x l�r�i� 3 7o/, (FACiR 8) <br /> TOTAL CaPAGTY IGALI VPI-GAmGcP F <br /> COmmmTS <br /> OWNER OF SITE ADDRESS <br /> * CITY STATE 2IP CODE <br /> OWNER OF TANK ADDRESS ! <br /> CITY <br /> STATE 2IP CODE <br /> CO <br /> UNTY ('�''• _ _��>L - .. _ . r <br /> 1. . <br /> TECHNI CIAm(S p IR <br /> � <br />