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Data Chart for Tank System Tightness Test <br /> petro Tite <br /> TANK TESTER <br /> PLEASE PRINT / <br /> 1. OWNER Prop.nr ❑ GUSr"t�1 Hhn lionF rN•shw <br /> ,,rr--//.� Nein• AOEr•Y a•er•••n,arW <br /> Tank(l)/TpGl MweeamNWe TN.oheee <br /> ��VV//���� N.m• AEOr•Y <br /> 2. OPERATOfl S <br /> Native TN <br /> N• •MW <br /> 3. REASON FOR <br /> TEST _ <br /> (Explain Fully) <br /> 4. WHO REQUESTED Nam. tree Comuny or ANuallon Dae . <br /> TEST AND WHEN T.I.NyoM <br /> Addm <br /> S. WHO IS PAYING SOv?JI !9Nr) GIR red. <br /> Comwnyff.Assn,or InakbuN Pman AWMrmna TN•arreea <br /> FOR THIS TESTI <br /> ennne wadeu un seat• z4 <br /> Ap.nlb.at: Order No. Omar Inar.•,bns <br /> Identity by Direction Capacity Brand/Supplier Grad. Approa.Age Steal/Fiber9teea <br /> 6. TANK(S) INVOLVED <br /> �U nK Dl�oa rlr/t�5 4L <br /> G •f� D,DOd C�/� �E <br /> re <br /> �X aloov R>< v1�� S?�fL <br /> Location Cover Fills Vents Siphons$ liumps <br /> 7. INSTALLATION �for7G/?6T/� i) 7/ Ato <br /> DATA n�u 2 ff4kE <br /> North In.w.drlr•w.y. C......ease Top. Sir..Tli. A..Oros suction.lt.erete. <br /> nor N paWq s,c, Lek.•k. boss.Parma M. sus,stimulated I Which uMa l Male y hanee <br /> 8. UNDERGROUND Isthewaterovermatankt <br /> WATER Depth to the Water,aba =x&- No <br /> Tank$to be tilled_hr, Data Arranged by <br /> 9. FILL-UP N.m. TN•ONn. <br /> ARRANGEMENTS Erna product to"top sett"and run TSTT. How and who to provid.7 Consider NO Lead. <br /> Terminal or other contact <br /> for notice o,Inquiry Name TN•Mene <br /> COrnp.ny <br /> 10. CONTRACTOR, <br /> MECHANICS, <br /> any other contractor <br /> involved <br /> 11. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> Additional inlormatbn an any ium$above.011kiafa or otMr$m M advised when ualirp is in progress or wmpbad.Visitors or oWernn pwm <br /> during test etc. <br /> Testa were made on the above tank systema in accordance with teat procsdures prescribed for FP1ro T11P <br /> 12. TEST RESULTS a detailed on attached test charts with results as follows: �"' <br /> Tank ldentitkatwn Tight Leakage Indicated Oats Tested <br /> 0' <br /> 1 / <br /> Thli Is to car1lty that Nese tank systems were tested on the details)shown.Those Indicsted as'-Tight'meet the criteria ealabNahed by <br /> 13. CERTIFICATION the National Fire Protection Asoclatlon Pamphlet 329. <br /> F' Lawrence Tank Testing 04n.,�_ <br /> 0... P.O. Box 407 By: Ignerar• <br /> S."No..of ThermN T.cn.kam Downieville,California 95936 (916) 289-3109 <br /> San. <br />