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Page 5 OUSTOMER: � C SITE PREPARATION AND SYSTEM DATA THREE -TANK SYSTEM DATE: LOCATION NO.: / SYSTEM NO.: — PRODUCT: CITY/STATE: SITE PREPARATION OTHER CONDITIONS VAPOR RECOVERY ❑ PLUGS DgISERSEl� OTHER VENT El NO PREPARATION I�OPEN TO ATMOSPHERE ❑ P -V VALUE REMOVED ❑ OTHER ❑ REMOTE/SUBMERSIBLE (DEPTH 1 ❑ SUCTION (HEIGHT ) CHECK VALVE STRAINER IMPACT VALVE CHECK VALVE STRAINER SUCTION.CONNECTION ❑ REMOVED & OPEN IN PLACE ElCLOSED REMOVED &COVER REPLACED ❑ REMOVED / RJ I1� PLACE el REMOVED &COVER E]REMOVED REPLACED ❑ OTHER ❑ CLOSED PLUG-IN E]CLOSED PLUG -OUT I --y ❑OPEN ❑ BURIED ❑EXTRACTABLE ❑ REMOVED ❑ IN PLACE REMOVED & CAP REPLACE ❑ REMOVED FI IN PLACE / C-] REP(,/�R:EfI& COVER OTHER /- ❑ UNION ❑ COUPLING WITH FOIL ❑OPEN NO FOIL �_7 U IN PLACE ❑ OTHER 4 r❑ u OTHEB,✓ ❑ OTHER AVERAGE T ❑ C ❑ OTHER TC = CC'S Q ,,jDIVISION TAN?2M TEST 1 DATA TANK 1 TANK 2 TANK 3 LOCATION DROP TUBE LOCATION DROP TUBE _ LOCATION DROP TUBE e FILL Gauge other (Specify) IN OUT Non FILL Gauge Other (specify) IN OUT None FILL Gauge Other (Specify) IN OUT Non T. PROBE - BALANCE LEVELS Time Tank 1 Tank 2 START O� END LEAK RATE iLR)AL ULA N LR = ±A DIVISIONS X CALIBRATION, CC = CC IN OUT MINUTE DIVISION MINUTE LR = —4— I 1 3 � z TEMPERATURE COMPENSATION (TC) CALCULATION COEFFICIENT OF EXPANSION 1/ �F CALIBRATION 3785 GT CE D*F CC LOCATION � METHOD p -j 'IJ SOLID ROD ❑ LIQUID OR 1 2 3 4 5 6 AVERAGE T ❑ C ❑ OTHER TC = CC'S Q ,,jDIVISION TAN?2M r, TANK 1 TANK 2 TANK 3 TOTAL SYSTEM CAPACITY, GALLONS oTemp. J Differential'TCT - Time of Temp. AVG. CC'S/DIV 3. --- Differential, Min. LEAK RATE iLR)AL ULA N LR = ±A DIVISIONS X CALIBRATION, CC = CC IN OUT MINUTE DIVISION MINUTE LR = —4— I 1 3 � z TEMPERATURE COMPENSATION (TC) CALCULATION COEFFICIENT OF EXPANSION 1/ �F `fir= 3785 GT CE D*F CC IN OUT GRAVITY TEMPERATURE,�F TC = TIME - MINUTE OR SOURCE ❑T159C ❑ A ❑ D ❑ B ❑ E ❑ CHART ❑ PUBLISHED DATA AT 60OF ❑ C ❑ OTHER TC = TANK 1 TAN?2M r, TANK 1 TANK 2 TANK 3 TOTAL SYSTEM CAPACITY, GALLONS oTemp. Differential'TCT Time of Temp. / --- Differential, Min. ABSOLUTE LEAK RATE (ALR) CALCULATION 'A ABSOLUTE LEAK RATE _ "+ TEMP. COMPENSATION `C/ L TE - � � � � 1989 X 0.015852 " - CC/MIN GAL/HOUR ❑ IF ALR > ± 0.05 GPH, A CHECK TEST WAS CONDUCTED WHICH CONFIRMS THE ABOVE RESULTS (CALCULATIONS ON CHART) ❑ A CHECK TEST WAS NOT CONDUCTED. - • 60 MINUTES/HOUR T 3785 CC/GALLON = 0.015852