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WORKSHEET FOR SUBMITTAL TO GOVERNMENTAL AGE <br /> NCY <br /> OVHER/OPMATOR_Z7,,eE3/ 2i"ClC.F, -Ae. 91J0 L <br /> _ zc) / SITE ADDRESS <br /> CIIL couNn �fA6CJ cTZIiBT�kJI.v <br /> HAtLI}lp ADDRESS AlSITE AGMt <br /> /�.�,, - TELEPHONE t9/�) �J'Z — 74¢f• . <br /> ARRiv® TEST EITTV/7"POURS YAWN LOCATION W2S7' <br /> DATE/TINE STORAGE FILLED 10 � 7PRODtlCT�jj07jJT+ <br /> PRODUCt LEVEL AT ARR1I �INCPES BEtAN 70P OF FILL NOMINAL LANK SIZE <br /> TARN MATERIAL AFPROx. TANK ACE���•y/s7 TRS, FILLEIZE/TTFE_.�Ovp�ILL CmAt"Im 7TTE <br /> AI'I CRAVI7Tsd_ZAT 7d DEC. F. AFI GRAVITY or-0 f 60P . COEFFICIENT OF ExrANsION or .000 G6/9S '- cot'Z66Jz. <br /> VISABLE VENTING ArPREARS TO BE AT, ILL OrOSITE —- <br /> HAS BURP TUBE, HAS BALL CHECK NR'NWN ptP FR <br /> VISARLE VAPOR TRAPS TO BE BLED: BALL CHECKS, ILL <br /> REIURN LINES, OTHER <br /> TRASE II VATOR RECOVERT STST"I, BALANCED, ASPIRATOR ASSISTED, LONG RUN WELLS, N/1RtFDLD®, pNE <br /> rNRNtNG SYSTEM, SUCTION, TURBINE MARE � OTHER <br /> MODEL PIPE LIRE LEAR DetectorNO; NOT ATPLTC <br /> CHARTED EIZL So63 E57. LIRE QUANTITY /0 FAODUC7 ADDED 7O FLOOD SYSTES TLE, <br /> MSYSTEM TONAL CALLOUACE X078' <br /> AHBIFHT CONDITIONS: TFHPf PRETEST �rOSTE97Kig;;i3 <br /> DURING x1,, CLOUDY, RAIDING, WIRDT, BpICRt, DINER <br /> .6 PSI DROP//W NpNNS TEST 70 STAR➢�rja no <br /> UES FSI TO BE MAINTAINED ON TANK BOTTOM D` TEST PERIOD / <br /> _ � Z rsi <br /> A. CMrW TO TAN[ RURON <br /> o K. GRADE TO TASK TOP 47414 <br /> A�AO� C. TMK OIAIRrTTR .7 <br /> 777, <br /> TZ-~ D, TEST LBMOL ARO" AM 3O <br /> ' � B. EXTERN RATTR AAO" TANK <br /> F 17_ Rorrwo�IN. K .0361 rsl . Z7 <br /> _ F, /0P OF FILL TO POW, AT ARRIVAL <br /> 0, TOP OF FILL TO IOP Of TART 36 V <br /> 1 pith. TTJr:.Ittet�Te w" of turK / <br /> RATTR sloe C rsl PER INa or PNND". "y oz6/ <br /> €L� TANT . . / TEST PElarr PRESSURE FORMULA <br /> 0L6/_ It, 7 <br /> REMARKS: H• Psi E. rsN NEr rsN <br /> RESULTS . <br /> THE L TEST PERIOD AS SHOWN ON THE ATTACIIED COMPUTER GENERATED DATA REFLECTS A <br /> LOSS t2qAiF,4;Cr,0 GALLONS PER HOUR} WITH A 997, CONFIDENCE LEVEL OF Bp)}, <br /> THE HORNER EZY CHEK II TEST METHOD COMPLIES WITH EPA SAND ')TIE STATE OF CALIFORNIA PERFORMANCE STANDARD OF 0.05 GPN <br /> FOR TANK INTEGRITY TESTING. (SECTION 2643 CALIFORNIA CODE OF REGULATIONS) BASED UPON THIS STANDARD, THE RESULTS <br /> SHOWN ABOVE: LT'EA% DOES NOT INDICATE AN UNAUTHORIZED RELEASE EQUAL TO OR GREATER THAN THE 0.05 GPM STANDARD. <br /> INTEGRITY TANK TESTING, S'r}1/)}'VICES, 166 FRANK WEST CIRCLE, STOCKTON, CCA., 95206, (209) 466-8036 or/(80 ) 2(2�-8378 <br /> CERTIFIED TESTER JjOP/A�Q.Lj(� STATE LICENSE 0 I��`U�� TEST DATE IP �J� -/ ' <br />