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A� <br /> �I WORKSHEET FOR SUBMITTAL TO GOVERNMENTAL AGENCY <br /> OWNER/OPERATOR OiA.tlE�L,/i7 �/G!/C«/.CJ'4 SITE ADDRESS <br /> CITY STLAiG�/�, COUNTY <br /> NAILING ADDRESS <br /> SITE AGENT �y/QGy /}f )�E.�, ��C TEL Q�) 94`Jy <br /> sppp <br /> ARRIVED TEST SI O//URS TANK LOCATION 4! CO� T/f ;*Z PRODUCT�/• G �/r/,es,� r,�,,�- <br /> DATE/TINE STORAGE FILL--;//A*%RODUCT LEVEL AT��AJRRIVAL INCHES BELOW TOP OF FILL NOMINAL TANK SIZE �l �Q <br /> TANK MATER2AI IAE �� APPROI. TANK AC�444 TRS, FILLSIZ.F/TYPE Q OVERFILL CONTAINMENT TTPF.10 <br /> APT GRAVIn _9 AT DEC. F. - API GRAVITY 0F-9t. R 6OF - COEFFICIENT OF EXPANSION OF .ODD �SS69 - COE �•S� <br /> VISABLE VENTING ArPRLARS TO BE All FILL END, L OPOS2TE E7H1 HAS BURP TUBE, HAS SALL CHECK, UNKNOWN, OTHFR <br /> VISABLE VAPOR TRAPS TO BE BLED: BALL CHECKS, NANWAYS, RETURN LINES, OTHLR <br /> PHASE 11 VAPOR RECOVERT SYSTEM: BALANCED, A�SPI,R(ATOORR ASSISTED, LONGBy" WELLS, MAHIFOLDED, PONE, OTHLR <br /> PIRTTNC SYS7PIIr SUCTION, E AKL �QGFCi'jl�� DEL —PIPE LINE LEAR Detectors TP.S, No App[tC <br /> CRAATEO SIZE lZ000 EST. LIRE QUANTITT/D PRODUCT ADDED TO FLOOD SrSTLN SYSTEM TONAL GALLONAGE <br /> AMBIENT CONDITIONS: THP: rRETEST44 POSTEST CLOUDY, RAINING, WINDY SRL CqY, OTHER /J <br /> .4 PSI DR(� HOURS TEST TO STAR / ROURS�PSI TO BE MAINTAINED NK ON TABOTTOM DURING TEST PERIOD Ts 5 PSI <br /> A. CMDF TO TANK BOTTOM Z <br /> Q� B. CUM TO TANK TOP Z7 <br /> 6.PiTA C. TANK DIAMETER S Z. <br /> D. TEST LEVEL ABOVE CRAVE <br /> G3�' 1 ',Z Z�q• eF� E. EXTERNAL GROUND NATER ABOVE TAN[ <br /> BOTT01 /N. K .0761 PSI - <br /> 7b F. TOP OF FILL TO PROD. AT ARRIVAL <br /> C. TOP OF FILL TO TOP OF TANK <br /> H. TEST.^.LBTEL'TOtOTTd OR TAN[ <br /> RATER IN OE I /Y PSI PER INLH OF PRODUCT � �/ ' <br /> ETANK / TEST HEIGHT PRESSURE FORMRA <br /> REMARKS: N. PBI rsI xFI PSI <br /> RESULTS <br /> THE FINAL TEST PERIOD AS SHOWN ON THE ATTACIIED COMPUTER GENERATED DATA REFLECTS A <br /> LO / GAIN OF:--,a, GALLONS PER HOUR, WITH A 997 CONFIDENCE LEVEL OF +/- �.pp/ Rph, <br /> THE HORNER EZY CHEK II TEST METHOD COMPLIES WITH EPA AND THE STATE OF CALIFORNIA PERFORMANCE STANDARD OF 0.05 GFH <br /> FOR TANK INTEGRI T SECTION 2643 CALIFORNIA CODE OF REGULATIONS) BASED UPON THIS STANDARD, THE RESULTS <br /> SHOWN ABOVE: 9fjp� ADES INDICATE AN UNAUTHORIZED RELEASE EQUAL TO OR GREATER THAN THE 0.05 GFH STANDARD. <br /> INTEGRITY TANK TESTING VICES, 41 WEST YOKUTS ST. STOCKTON, CA., 952077, (209) 474-1375 or (80y0�) 2262 37& <br /> CERTIFIED TESTER STATE LICENSE 4�0 -ID 1i� TEST DATE (� v <br />