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WORKSHEET FOR SUBMITTAL TO GOVERNMENTAL AGENCY <br /> OWNER/OPERATOR_�i���G/`� TiP.� ��e� SITE ADDRESS Gi �-' ���j�+�_/✓�-�k�A <br /> CIn %)-z='l��i COUNTY <br /> HAILING ADDRESS <br /> SITE ACEfri Ti7.EPHONE <br /> ARRIVED TEST SITR//.-*' HOURS TANK LOCATION PRODUCT_ <br /> DATE/7IHE STORAGE FILLED S Z7 PRODUCT LEVEL AT ARRIVAL INCHES BELOW TOP OF FILL NOKINAL TANK SIZE <br /> TANK MATERIAAAL'' APPROX. TANK AGft T/TRS. FILLSIZE/TTFE el OVERFILL CONTAIid¢NT TYPE � J <br /> APT GRAVITTw *_ AT/CODEC. F. - API CRAVITT OFj�4_a 60F - COEFFICIENT OF =ANSION OF .000 <br /> VISA-BLE VENTING APPREARS TD BE AT: FILL END, FZLL OPOSITE - COE �7J <br /> HAS BURP TUBE, HAS BALL CHECK, UNKNOWN, OTHER <br /> VISAILE VAPOR TRAPS TO BE BLED: BALL CHECKS, HANWA7S, RETURN LINES, OTHER <br /> PHASE II VAPOR RECOVFAT STS�TEX: BALANCED, ASPIRATOR ASS I=. LANG RUN WELLS, NANIFOLDEDIVONEy OTHER <br /> PUMPING 5752P1t: STICTION, (ZURg I}71;' MAKE �—�L C��t�MODEL 1 PIPE LINE LEAK De CeCtO TES, H0; NOT APPLIC <br /> CHARTED SIZE /ZGYxJ EST. LINE t)OANTIZ7���C/PRODUCT ADD® 10 FLOOD STSZZH STSZ�1 SORAL GALLONAGE Zz`%! / <br /> AHBIENT CONDITIONS: IEHPt PRETEST �POSTPST J/ — <br /> ,,��JJ//� RS /� � CLOVDI, RAINING, WINOT, BREEZY, NIGHT, OTHER <br /> .4 PSI DRt7t�3ROUTEST TO 52A11S�- HOURS PSI TO BE HAINFAINM ON TANK BOTTOM DURING TEST PERIOD - A 5f,S <br /> _ /PST <br /> A. CRAVE TO TANK KOFILM <br /> Q t. GRADE TO TANK ror -31 <br /> 6�^OE Co TANK OIA%MTER / S <br /> 0. TEST LEVEL. ABOVE GRADE _ AF <br /> G.3y E. BKTEULIL CROt" WATER ABOVE TANK <br /> N O361 I <br /> F. TOOT 0 ARI <br /> FILL TO PR00. AT AVAL <br /> A C. TOP OF FILL TO TOP OF TANK <br /> qj H. TPST:LRVLCTOIOROI OF TANK 1¢S <br /> WATER IN C PSI PER INW OF PROOIICT D =03 <br /> TAN[ / <br /> E / TEST iTEI6R PRESSURE FORNR.A <br /> REMARKS: N. Psi E. rsT NET PST <br /> RESULTS <br /> THE FINAL TEST PERIOD AS SHOWN ON THE ATTACHED COMPUTER GENERATED DATA REFLECTS A <br /> C33 / GAIN OFv,(�CALLONS PER HOUR, WITH A 99% CONFIDENCE LEVEL OF +/- AGC, gph. <br /> THE HORNER EZY CHEK II METHOD COMPLIES WITH EPA AND THE STATE OF CALIFORNIA PERFORMANCE STANDARD OF 0.05 GPH <br /> FOR TANK INTEGRM(SECTION 2643 CALIFORNIA COAD OF REGULATIONS)BASED UPON THIS STANDARD THE RESULTS <br /> SHOWN ABOVE DO OT INDICATE AN UNAUTHORIZED RELEASE EQUAL TD OR GREATER THAN THE 0.05 GPH STANDARD <br /> INTEGRITY TANK TESTING�DIVV FOIL EQUIPMENT SERVICE, P- 0-80)(950, SAN ANDREAS, CALIFORNIA 95249 (209)754-1808 <br /> CERTIFIED TESTER _�L��PGt -,0 LICENSE p DATE S J J <br />