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. . , . .. , DATA CHART <br /> For Use With <br /> T <br /> _ l t , <br /> 1 LOCATION : <br /> O Street No. and/or Corner City State Telephone No . <br /> Z p 2 OWNER : <br /> Name F Address Representative Position Telephone No. <br /> man <br /> 3 OPERATOR : <br /> Name Doale6M``p r. or Other Address ( II different than Location ) Telephone No , <br /> 4 REASON FOR TESTI ��' � r.i�flKCPS <br /> I <br /> Z r ) � <br /> ' 6 TEST REQUESTED BY : <br /> V) O H Name Position Order No, Billing Address <br /> i SPECIAL INSTRUCTIONS : r <br /> 7 CONTRACTOR OR COMPANY MAKING TEST �j , , s 1 , <br /> MECHANIC ( S ) NAME \ L/ <br /> _ " S IS A TANK TEST TO BE ❑ YES D MAKE AND TYPE OF <br /> 0 <br /> w1'�� <br /> N MADE WITH THIS LINE TEST ? PUMP OR DISPENSERS - <br /> NO <br /> �° p O \ y4 .. COVER ( � \�', C r I APPROXIMATE ' <br /> 10 WEATHERWC TEMPERATURE IN TANKS _ $ F ° C OVER LINES. w BURIAL DEPTH <br /> Condole, Black To6, etc. <br /> 14 PRESSUHE 16 VOLUME F 16 TEST RESULTS <br /> 11 IDENTIFY 12 TIME 13 LOG OF TEST PROCEDURES, <br /> EACH LINE AMBIENT TEMPERATURE, pal OFA kPa READING <br /> AS TESTED ( MILITARY) WEATHER, ETC, NET CONCLUSIONS, REPAIRS AND COMMENTS <br /> BEFORE AFTER BEFORE AFTER CHANGE <br /> SIU <br /> im"PS,.orl Sol <br /> - al , �' <�� ': Cplim.Plf� <br /> o_ � <br /> CIC <br /> -tis-----� <br /> SIP <br /> Paw <br /> k0�, <br /> C itSof <br /> 1 L4 <br /> r' POP <br /> SIP <br /> Ll.�-G cxa Iv-� �� <br /> mot <br /> I — 1 L <br /> U 4- . <br /> SIP <br /> of 414 1 <br /> . . 41101 0 1 1 . <br /> - - - . . So <br />