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!T <br /> /7 WORKSHEET FOR SUBMITTAL TO GOVERNMENTAL AGENCY <br /> OWNER/OPERATOR ^47-2'2'� � SITE ADDRESS <br /> CITY �/�f'i5��/�i.�_ <br /> couNT� <br /> HAILING ADDRESS f ' ]( ���� 9.�LC5, <br /> SSTE AGFA'[ ��L� / TELEPHONE <br /> ARRIVED TEST SIZE12DIOURS TANK LOCATION G I( PRODUCT <br /> DATE/TUE STORAGE FILLED - Z7 PRODUCT LEVEL AT ARRIVAL ` INCHES BELOW TOP OF FILL NOMINAL TANK SIZE <br /> TANK MATERIAL_ APPRO2. TANK AGO TRS. FILLSIZE/STYE—_1�7 09ERFILL CONTAINMENT 'TYYPP'E <br /> A <br /> APT CRAVT--7/, AT �DEC. F. - API GRAVITY 09/. Z 6OF - COEFFICIENT OF EXPANSION OF .000 47�7'�/�. COE _¢1_o_' <br /> VISABLE VENTING APPRLVLS TD BE AT: FILL <br /> .ZILL OPOSITE END, RAS BURP TUBE, HAS BALL CHECK, UNKNOWN, OTHER <br /> VISABLE VAPOR TRAPS TO BE BLED: BALL CHECKS, IlAINA25, LINES, OTHER <br /> PHASE II VAPOR RECOVERY SISSIZII BALANCED, ASPIRATOR IF <br /> ASSSISTED, IANC RUN WELLS. HANOLDED.\AOn THENPUMPING SYSTEM: SUCTION, TIIRB IF2 HAKE / —/ PIPE LIKE LLA[.DeteCtOLq YRS./NO; NOT APPLIC <br /> CHARZG2z <br /> TED SIZE / % LST. LIRE OOAATI277U PRODUCT ADDED TO FIAOO SISTER�SISTER TORAL GALLONAGE <br /> AMBIENT CONDITIONS: TEMPI PRLTEST�POSSLS7,( CLOUDY, RA2NIHC, WINDY, BREEZY, NIGAI, OTHER <br /> .4 PSI HOURS TEST TO STAIgp«AOUIL4 PSI TO BE HAIRTAINED ON SANE BOTTOM DURIHC TEST PERIOD S <br /> PSI <br /> A. CRUDE TO TAN[ sORGI <br /> 0 Z4 B. CAM TO TANK TOP G`> <br /> 6.GIOF C. TMC OIAWTER <br /> 777777� Ll — - <br /> (-3g0. TEST Ltva ABOVE GRADE �JP� <br /> —>�-— z5 c� <br /> _ B^� B. P37BRUI. CROWD WATER ABOVE TANK <br /> ' G TE _ 'A� IO rc" IN. 2 .0561 PSI _ <br /> N �F F. TOP OF FILL TO FEW. AT ARRIVAL <br /> /9 JzC 0. TOP of FILL TO TOP OF TANK 3S� <br /> (}` H. TT:S]T=5 TO'7OFTON UP TING --r�� <br /> BATES INSIDE C PSI PER INCH OF ►100:1cr <br /> E- <br /> TANK • TEST HEIGHT PRESSURE TOAEILAPS <br /> REMARKS: H. PSI E. Psi WET Psi <br /> RESULTS <br /> — THE FINAL TEST PERIOD AS SHOWN ON THE ATTACHED COMPUTER GENERATED DATA REFLECTS A <br /> LOS5 / GAIN OF4-42;7 GALLONS PER HOUR, WITH A 99% CONFIDENCE LEVEL OF +/- ,L� <br /> / �`- <br /> - 8ph. <br /> THE HORNER EZY CHEK 11COMPLIES WITH EPA AND THE STATE OF CALIFORNIA PERFORMANCE STANDARD OF 0.05 GPH <br /> FOR TANK INTEG G($EO TION 2643 CALIFORNIA COAD OF REGULATIONS)BASED UPON THIS STANDARD THE RESULTS <br /> SHOWN ABOVE. S NOT DICATE AN UNAUTHORIZED RELEASE EQUAL TO OR GREATER THAN THE 0.05 GPH STANDARD <br /> INTEGRITY TANK TESTING DIV. F OIL EQUIPMENT SERVICE, P.0.BOX 950, SAN ANDREAS,CALIFORNIA, 95249 09)754-1808 <br /> CERTIFIED TESTER_J�B9�. LICENSE# 9O hoz 3 DATE �'-�i <br />