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DATA CHART <br /> For Use With <br /> V601TILIP <br /> 1 LOCATION : 67I © � �+ I <br /> E <br /> w Street No. end/or Corner City State Telephone No. <br /> Z <br /> Z <br /> p 2 OWNER : - ,!' = <br /> Name Address Representative Position Telephone No. <br /> 3 OPERATOR : 'Sk"" ti <br /> NomeDealer, Mgr, or Other Address ( if different then Location ) - Telephone No. <br /> ' <br /> 4 REASON FOR TEST . <br /> u `— ( O <br /> 67 <br /> 6 TEST REQUESTED BY : <br /> '� ✓�+ U Name Position Order No, Billing Address <br /> O t� <br /> v � J 6 SPECIAL INSTRUCTIONS : <br /> 7 CONTRACTOR OR COMPANY MAKING TEST �— <br /> MECHANIC ( S ) NAME c JC�71' � �� . ' OIJ ./ G Q �dZcr I � r <br /> 8 IS A TANK TEST TO BE YES 8 MAKE AND TYPE OF <br /> ~n MADE WITH THIS LINE TESTS r—y PUMP OR DISPENSERS <br /> m` o r'o Q L74 NO �, ,, PVER r i <br /> r 10 WEATHER U N^ TEMPERATURE IN TANKS -I -lo OF °C OVER LINES ePJ " "` - — � BURIAL ( DEPTH <br /> Concrete, Bleck Top, eta <br /> 14 PRESSURE 16 VOLUME 16 TEST RESULTS <br /> 11 IDENTIFY 12 TIME 13 LOG OF TEST PROCEDURES, NOMMEW <br /> EACH LINE ( MILITARY ) AMBIENT TEMPERATURE, psi OR kPa READING NET <br /> AS TESTED WEATHER , ETC, CHANGE CONCLUSIONS, REPAIRS AND COMMENTS <br /> BEFORE AFTER BEFORE AFTER <br /> I fro , e ? � <br /> E>7 7 f a? 3 , � o4 <br /> wwww <br /> I 'D , a7 3 • 07 l <br /> co <br /> e d7 0 / c7 ? L <br /> t 'Oij � r D �6 �� c�� 4i <br /> vS2 <br /> 0 r <br /> I ' S <br /> 7(e 7 � 0 '4s�- . O�j t' OosoL. <br /> wwwww <br /> 1 � Y C7 w) 4aj (c r 00 <br /> i <br /> Jin // c� 0 <br /> 02 <br /> r o.w) 007 ILo0 <br /> www- <br />