Laserfiche WebLink
Data Cort for Tank System Tigh1w Test <br /> petro Tife <br /> PLEASE PRINT TANK TESTER M� � <br /> 1. OWNER Property 11 6ecgzniz� Z L / W T <br /> Name Address Rep®semauea (y.1Telephone <br /> Tank(a) <br /> Name Address Reoresentatire TNephona <br /> 2. OPERATOR Name Address Telephone <br /> 3. REASON FOR <br /> TEST <br /> (Explain Fully) <br /> 4. WHO REQUESTED <br /> TEST AND WHEN Name Title ComwnY or ANil4don Data <br /> AddrM Telephone - <br /> 5. WHO IS PAYING Common,Agency or Individual Person Aumorlxing This Telephone <br /> FOR THIS TEST? <br /> Billing Address City State Zit <br /> Attention at Order No. Other Instructions <br /> Identify by Tin Capacity Brand/Supplier rode Approx.Age Steel/Fiberglass <br /> 6. TANK(S) INVOLVED <br /> tCj <br /> Location ) Cover Fills Vents f Siphones Pumps <br /> 7 DATA INSTALLATION ��� b t. e Z jl � ��Gy✓IQ <br /> _I <br /> i eel <br /> ConcreL.Bleck Top, Size,Titelill make,Drop Suction,Remote. <br /> Re r I tc, Earth,etc. tubes,Remote Fills Six,Manifolded Which tanks? Make if in. <br /> 6. UNDERGROUND p Is the water over the tank? <br /> WATER Depth to the Water table T f11El Yes No <br /> Tanks to be filled hr. Date Arranged by <br /> 9. FILL-UP N.M. Telephone <br /> ARRANGEMENTS Extra product to-top off'and run TSTT. How and who to provide? Consider NO Lead. <br /> Terminal or other contact <br /> for notice or inquiry Name Telephone <br /> Camp... <br /> 10. CONTRACTOR, <br /> MECHANICS, <br /> any other contractor <br /> involved <br /> 11. OTHER <br /> INFORMATION ClAled, C f <br /> OR REMARKSrtional l i <br /> Additiinformation on any items above.Ofbcials or others to be advised when testing is in progress or completed.Visitors or observers present <br /> during test etc. <br /> Tests were made on the above tank systems in accordance with test procedures prescribed for Ip0{fe <br /> 12. TEST RESULTS as detailed on attached test charts with results as follows: 'w�'ss'I= <br /> Tank Identification Tight Leakage Indicated Date Tested <br /> X4-:0 n p <br /> .Qp 1 <br /> This is to certify that these tank systems were tested on the date(s)shown.Those indicated as"Tight"meet the criteria established by <br /> 13. CERTIFICATION the National Fire Protection Asociation Pamphlet 329. <br /> Lq.tglllti/ D�� " S' �ecko� Lnd>xtrr?5 <br /> Data Testing Cpnvacm1u( <br /> �of Comw Br. Sienae <br /> zE� L3 _ C!r/Se <br /> Sepal t of TNBnr161 / Tecnmmans 1 Adoress <br /> Senora, Far)V_ '10 `r <br />