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5� <br /> DATA CHART <br /> For Use With <br /> petro T!f4 <br /> 1 LOCATION: ��\ �l/ /30 —�� C,/i <br /> s, 4 <br /> Street No.and/or Corner Clly State Telephone No. <br /> v„ b W <br /> Z <br /> = 3 <br /> O 2 OWNER: <br /> Name Address Representative Position Telephone No. <br /> 3 OPERATOR: <br /> pName Dealer,Mgr.or Other Address(II different than Location) Telephone No. <br /> — a 4 REASON FOR TEST_ <br /> � O <br /> Q 5 TEST REQUESTED BY:� <br /> y) U N U Name Position Order No. Billing Address <br /> O B SPECIAL INSTRUCTIONS: <br /> 7 CONTRACTOR OR COMPANY MAKING TEST J�� 7� � //! �/• /I ���/� /� �j //�/ <br /> MECHANIC(S) NAME <br /> 7 <br /> -�j <br /> a 8 IS A TANK TEST TO BEYES 8 MAKE AND TYPE OF Q / <br /> V)) MADE WITH THIS LINE TEST? PUMP OR DISPENSERS <br /> >ar <br /> N O <br /> } p ,� COVER yCY PPROXIMATE <br /> 10 WEATHER Gu@�� TEMPERATURE IN TANKS✓6� -F •C OVER LINES / /���� BURIAL DEPTH <br /> Concrete,Blac Top,e16. <br /> 14 PRESSURE 15 VOLUME 18 TEST RESULTS <br /> 1 IDENTIFY 13 LOG OF TEST PROCEDURES, <br /> 12 TIME <br /> AMBIENT TEMPERATURE, psi OR kPa READING NET <br /> EACH LINE (MILITARY) CONCLUSIONS, REPAIRS AND COMMENTS <br /> AS TESTED WEATHER, ETC. CHANGE <br /> BEFORE AFTER BEFORE AFTER <br /> DS <br /> 4,3 12 VV �)3 e_-;O� .2o <br /> I`ao 43 Z��io v3Lh .�, <br />