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WORKSHEI OR SUBMITTAL TO GOVERNMENTAL I&CY <br /> GIVNER/OPERATOR MGM. JLU-- _Q i R,ol.Qum SITE ADDRESS__1-AlH4„0? ZfD 99 <br /> CI'IY� 1-v%R w1 .A COUNTY 514v Zt>AGVt-m - - <br /> MAILING ADUR3ESS V*%ootA �r3C2�.0 vs�w� IDQ. 4ox. U-) Na ge qs Lq - <br /> SI'1'E AGENT Q. `M 'ITLE1'1100'( 1 ) 835 " -L S <br /> ARRIVED TEST SITF HOURS TANK LOCATION/NUIMPPI-laom O p]PR _G f 1RoDi1CT, �uQI�L 1]►�1✓ ► �� <br /> DATr./TIME.. STORAM FILLP.n I"'Ll"90 PRODUCT LEVEL AT A01VAI �1NOWS MUM Tor OF FILL NOMINAL TANK SIZE <br /> TANK RATERIAT r-ll)Rtt GLARF _,vrROK. AG¢_IS & YM. PILL SIZP./TTrPP�95 mr.mt.t. CONTAMIPHT TYPE 1�714���lJ <br /> Art ORlIV1n 5is-y AT S-22 mo. F. - Art CRAVITT OP 5�6 64F . COPFFtCIMIT Or r nislDlt Or: 11nn0011 COR Or u JL <br /> V15ARIP VENTING ArrEANS TO IF. AT: FILL ¢ND. j1LLOrr0SITR PR0 IDIS AURP ALL 01E anr¢st <br /> VTSARt.E VArOR TRAPS TO BE OLR.D: SMALL Q1PC , MANRAYS, OTHER 13(3umm. ZISn^6v im ' <br /> r sp 11 VArOR IO:OTIVPRY STSTP.N TYPE: BALANCE ASPIRATOR ASSISTED Mir RIR{ *E.LtS NANirOLDED NONE OTHER w, <br /> r111R'tfir S"l&: SUUC�(T�IM REIN MAKE,_ I?ZD �TM/9t .MODPL, Q� 55j PIPE LTNR I.PAK MECTORS LAK <br /> CIIAR.TFD TN+K sin lW 1 MSTIMAvm LINE QUNITITT 7Q.,,.,_rTe')n11Ct ADI)PP TO FL(rD SYSTRN.- -7 SYSTEM GALLONS TOTAL <br /> �r'4 <br /> ANRTENT WEATHER CONDITIONS: TP.NrERATTIRS rRETESlr0ST TMST RAININGOU WINDY NTc71T OTHER <br /> STSIEM FIAODEnd_�3Q_HOURS .+ r5! mW 1015 IIVUR.S PSI TO IR MAINTAINED ON TANK XOFTOM DURING TEST P¢RiDrt, Ll . S <br /> A. GRADE TO TANK PUTTOM 151 `h. <br /> 0 2.7 S. GRAnE TO TANK TOP IOD <br /> C. TANK DIAMP.R 1� <br /> 6 P�iA� 'LZ <br /> 77 1/77 <br /> D. TMST LEVEL ABOVE GRAM <br /> � 8 . EXTERNAL n RATER A>lOVE TANK <br /> u-� <br /> E �. <br /> 1lOTTOH____�Gr. IN. K .OS61 DSI <br /> - L E. TOP DP FILL TO TR <br /> ROD, AlAT AIVAL <br /> A ISII's C. TOP OF PILL TO TOP OF TANK y <br /> 11. Q31 t,bM.'TO'lMOM'O% TANK <br /> d+I I <br /> C PSI rER INCL OE PROM" GAS '�61 <br /> RATER INSInR <br /> pj TANK J q - TEST HRIMIT PRESSUR¢ rOMMA <br /> If. PSIe..vsi NPT PST- <br /> REMARKS <br /> SiREMARKS <br /> 111T; FINAL TE5'r PERIOD AS SHOWN ON THE, ATFACIIED COMMYFER GENFRAT17D DATA REFI.1?CTS A <br /> LOS / GA11V OF:—.0�q GALLONS PER HOUR, IVI'Hl A 99% CON1'IDENC E LEVEL OF +/ , C)d ___ (711. <br /> (!SING THE HORNER EZY CIIEK II HF311101) OF VESTING THE RESULTS AS SHOWN ARE S�TrllNOT IJ T111N 111E STATE 01T CALIFORNIA 29 GUID LINES OF A 1�1AYIIIUI<1 L <br /> GAIN OF .05 GALLONS PER HOUR i'q ANK I'0 BE CO SIDERE ) TIGff . <br /> INTE'GRI'TY TANK TESTING SYSTEMS, INC . .166 FRANK WEST CR.. <br /> STOCKTON, CA 95206 (209) 466-8036 or (800) 262-8378 <br /> CERTIFIED 'PESTER Awr j I14C W' TEST DATE <br /> gSIFFb' LIG. ' 9r- <br />