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CUSTOMER: <br />I.D. f ---- - -- ------- <br />TANK AND LOCATION DATA <br />CITY: <br />STATE: <br />Page 2 <br />DATE: — -- <br />WEATHER <br />TIME <br />TEMPERATURE <br />COMMENTS <br />BEFORE TEST <br />AFTER TEST – <br />SCHEMATIC: <br />u <br />APR 31989 <br />HEALTH <br />iSERVICES <br />(l <br />PRODUCT/TANK NO. <br />LEVEL <br />Fill <br />Gauge <br />Fill <br />Gauge <br />Fill <br />Gauge <br />Fill <br />Gauge <br />Fill <br />Gauge <br />LU >- <br />M <br />w <br />o J <br />GALLONS <br />w <br />CO o <br />WATER <br />TOP OF RISER <br />GRADE <br />DROP TUBE <br />CAPACITY, GALLONS <br />DIAMETER, INCHES <br />MATERIAL <br />PUMP TYPE <br />TYPE OF COVER <br />AGE OF TANK <br />SIPHON <br />TANK OPENINGS <br />EXTRACTORS <br />TYPE <br />} <br />cr <br />VENT CONFIGURATION <br />Ow <br />Q p <br />P -V VENT VALVE TYPE <br />Lu <br />REPLACEMENT PARTS: PART # <br />ADDITIONAL CHARGES: (pumpovers, overtime, etc.) <br />DESCRIPTION <br />"Data obtained from ❑ Station D LL Charts ❑ Other <br />QUANTITY PRICE <br />