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"pax a• •� t �k o'°� ! V. �,: <br /> F_ <br /> Et <br /> Data Chart for Tank System Tightness Test <br /> .petro.�' <br /> . ... OWNER prd arty Q� t7/�- llC - ZI S /All <br /> r� <br /> CI tA rTale ..-.i,fi,Pnone <br /> T:nkfaY 47 Nema Prtr <br /> Nems�s� Address�_ Ttlspnane <br /> 2. OPERATOR SAaME ASS .4-- --._ — --_ - — <br /> Name Addrns r T�Itgn°n.��y <br /> 3. REASON FOR TEST <br /> (Faptsln Fully) <br /> q, WHO REQUESTED CuSTesmFre <br /> TEST AND WHEN Name ComPsnyarAfrinel+cn Pus <br /> AEdidren <br /> 6. WHO IS PAYING4d — ---CoM -- <br /> FOR THIS TEST? MPaay.A00Y al lrWlvldual Rlraon AVlhOdylnq —YIIIe —��-Trlrphon.-- r <br /> Bullnp Address <br /> Allemlon a1: Order No. -- -Othar InmucdCna <br /> Idantlfybcti <br /> try Capacity Glade Approa.Age <br /> s. TANK(S)INVOLVED S1nYFIMrgleea ,/ <br /> 1.D00 <br /> 7. INSTALLATION Lmmion Covet -- Flll$ Vents Siphons Pump'. p <br /> DATA <br /> `--•' Hann made dmlwey- DWr,lt•buck Top, Size•fdaidl nuke.Mop - _— Make 4 pwr— <br /> peer o1 tl Atkn,tie. brth,etc tuba,P",eI U19Srer,Mamlbldrd Wnith unkrT k+aka,t}rpwn- <br /> 8. UNDERGROUND Is Ins we,erorarIna lank? <br /> WATER D,pitl to water table if known—� -- ❑ Yas L+J No <br /> 9. -FILL-UP 3:29-54_ - TNo � tL — �eB=afo9 <br /> ARRANGEMENTS Tank,tobeuuad, Dau Arranged Telephone <br /> N me <br /> Hour�:do Aril <br /> #0. <br /> TECHNICIANS7'AiF <br /> c <br /> t1. OTHER --- --- <br /> INFORMATIONOR REMARKS — T___T--- --- - ----- <br /> Additional Information on any hems Above.Officials or others to be advlsed when Is ling is In progress or completed.Vla+lora or obaorvers present-� - <br /> dudnq last.H4 - - <br /> TEST AESU LT$ Tnu was mods an Ina abal tank system@ In secorLnca with tett prx.dune prnalWd far <br /> y <br /> as details apt attached test chine with nate))%at 1040wa! <br /> ttnk Identlflgatlon Tlght Wltnln Tolarance- out of Tolerant. Osla Tatted <br /> �p , <br /> 1 CERTIF[CATIDN wou�alttoµ«tthaati e$�,i sZ�me rw iwe7s�an TM pa1Na1 Ne?wn Mae IndEuted as-Tlpm^moot tn.orlteda uubElshed by the Nawnal Fr. <br /> -� Name of person cettlfylnq - <br /> File Olt <br /> ftl <br /> •w //mayy D. �i� 3�3 46 _M , 1 r$TtNntr <br /> '.�a�` <br /> '.$eclat No.at Thermal Sensor Ggllcallon Nurnbar <br /> le <br /> aII-iE RE PRCUWrIO DE IMS <br /> D®CUYIENT GANWr BE <br /> IMPROVED DUE TO THE <br /> ORI 4 <br /> CONDITION4E THE DRf.GINAL. • <br />