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1., <br /> Data Chart for Tank System Tightness Test <br /> petro Tito <br /> PLEASE PRINT TANK TESTER <br /> 1. OWNER Property -1 C < _ vC,'- = r - i.1I` F1'/ r/ c- r <br /> Name - Address Frascati T.I.ph.ne <br /> Tanks) !X <br /> Name Address Nepresanunve Tere.n.e. <br /> 2. OPERATOR Nam. , Address rel.pno.. <br /> 3. REASON FOR <br /> TEST y -7 I,C-It lizi4le, r <br /> (Explain Fullr) <br /> 4. WHO REQUESTED <br /> TEST AND WHEN Nam. Tine company or Ashland, Date <br /> f4 v r- —L✓ I <br /> Address Telephone <br /> 5. WHO IS PAYING 5c(, 0. <br /> Com .y,Age.cy m IndlrlIl P rz Autnorst Tine rela <br /> 5— ' phone <br /> FOR THIS TEST? Ra. Ve _ <br /> alllinp Add as Ciry Stale Zip <br /> Attention ol: order No. Other lnatrpciwm <br /> Identify by Direction Capacity Brand/Supplier Grade Approx.Ape Steel/FiGrglass <br /> 6. TANK(S) INVOLVED v (711711 092; u k S <br /> c I tio V 0 0 pizeim-401 -fic;' <br /> Location Covx Fick Vents Siphons Pumps <br /> 7. INSTALLATION <br /> DATA Fie u."; CONK eTc If 2— <br /> North <br /> North Indde drlwwav, Concrete.slack Too. Sire.lmnll mob.Drop Suction.Ram. '. <br /> ii <br /> oe asspon.nc. Earth.etc, tu0ee Remote Fills Size.Menlloldad which tanks? Make if known <br /> 8. UNDERGROUND Is the water over the tank? <br /> WATER Depth to the Wei table year ❑ No <br /> Tanks to be filled 22CC' hr, 3_Z 5 -5 6Date Arranged by [c ti '//S - 46 ?-.77// <br /> 9. FILL-UP Nama rensonone <br /> ARRANGEMENTS Extra product to"top off'and run TSTT. How and who to provide? Consider NO Load. <br /> Terminal or other contact ��c N�� -o r�. <br /> for notice or inquiry <br /> Company Nein. ransom... <br /> 10. CONTRACTOR, — <br /> MECHANICS, <br /> any other contractor <br /> lnvoNed <br /> 11. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> Additional Information on any items above.Officials or others to be advised when testing is in progress or completed.Visitors pr observers present <br /> during test etc. <br /> Tellstraere meld on the above tank syaleme in accordance with test procedures prescribed for R! rtM <br /> 12. TEST RESULTS w dabi on attached test charts with results as toltowc _4w <br /> Tank <br /> Tank Identification Tight Leakage Indicated Date Tilted <br /> EVC - 1 -7 -ZF <br /> ep Ii yr <br /> - <br /> This Is to certify that mese tank systeme were tasted on the date(s)shown.Those indicated as"Tight"msel the criteria utablished by <br /> 13. CERTIFICATION - the National Flee Protection Asociation Permanent 329. <br /> Z-! `f -� c ,�R, rr 1) „�. rK Lawrence Tank Testing <br /> Desi T��_r P.O. Box 407 Dv: Simi <br /> - No.of 7Z ' 'L <br /> if <br /> SDownieville,California95936 (916) 289-3109 <br /> inal Thermal iecnnicuna <br /> Sensor <br />