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ata Chart for Tank Sn Tightness Test <br /> a <br /> PLEASE PRINT <br /> 1. OWNER property®�/ 1",17,G i%_ <br /> Tmkla)ISI Nmw mer - Hapavaenlalive Teleplpne <br /> �i11y!C -- <br /> Name Approval Hepraaantatrve telephone <br /> 2. OPERATORS <br /> Neoax A4fp. Telannone <br /> 3. REASON FOR <br /> TEST — — <br /> fExplamFullY1 - -- -"- -- <br /> 4. WHO REQUESTED <br /> TEST AND WHEN Nam. ndu Company o�nliiir;uo� --- -o;le-- -' <br /> Address Telephone <br /> blandly by Direction capacity Brand.S.Mler Orale Approx.Age SteellRbergless <br /> 5. TANKINVOLVED <br /> Usa eldnionsl rhea /-" Yf', ' dY _/ ,�•...- _ _ <br /> for miumfolded tank. <br /> Location Cover Fills Vants Srpnones Pumps <br /> 6. INSTALLATION ,l Ar• :, <br /> DATA JJ <br /> i'1`r ,.',, T yt "�� �''� "� I�IJ�It' x , . � . 'J•if <br /> North loansdnrewey. Concrete.Black Top. Soe.TiteG l mMe,Orop Suction.Hamm., <br /> Ren of euuan.who <br /> Eartr,erc tuar,Remote Fills Sze,k4ndo1ded Which tanks? Make It known <br /> 7. UNDERGROUND N the..far Diva In.rook? <br /> WATER Oepdn to the Wetenable 1` ` /".! 1 " J% ' <br /> _ ❑vet -IM <br /> 8. FILL-UP Tanks to be fined—_—m Date Arranged by __—_ _ <br /> Name Trial,hone <br /> ARRANGEMENTS Extra product to'top off and ren lank tetter How and who W providel Comider NO Lead <br /> Terminal of Other contact ^ <br /> Icer notice of inquiry _ <br /> Cpmpany Name Telephone j <br /> 9. CONTRACTOR, <br /> MECHANICS. <br /> any other contractor <br /> involved <br /> 10. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> Additional inlormalloa on any items u,r olnnals or others to be advrYd when teling is in progress or completed Visitors Of obYrvan parent during test,etc _T <br /> Tests were made on the above tank systems N accordance with teal Procedures prescribed for <br /> 11. TEST RESULTS a detailed on attached fest drab with revi m folows: <br /> Tank bdenbLeancn Tight LaakApe Indicated Ria Team I;:l <br /> __— <br /> i <br /> 12. SENSOR 13.This is to cod"that 9aae to*systems was heated on the date(.)mowny inose indtcwsd as-Nhr mew are whenks ewabilahed by ft <br /> CERTIFICATION National Flat Protection Association Far w! 729 <br /> I <br /> Tecnnmrens <br /> Dec. /✓I .� / <br /> Trdnp Conlr or or Company BY Sgnetm <br /> Sonar 3e of Thermal Cartllicarion x <br /> 2 AdLr'w <br /> I <br /> Carthlci don. <br /> pNMy1 <br />