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TELESIS 1450 Har Ivd., W. Sacramento, CA 95691 <br /> 1 I I <br /> Tank Testing T (916) 372-7535 <br /> AiNLAY TANK `TEGRITY TESTER T" FIELD TEST DATA <br /> 1 NAME ADDRESS PHONE C;zc? <br /> TANK S 'f % ��' t<fa. Sb6 G d1.tr, 7C <br /> OPERATOR <br /> 2 IDENTIFICATION CAPACITY--GALS. MANUFACTURER STEEL/FiBRGLS. AGE--YRS. <br /> .''..sem! t4 ,!5d G.1 uoA. <br /> TANKS TO 7S K 16 L/4 ks <br /> BE TESTED <br /> 3 WATER <br /> DISTANCE FROM GRADE TO WATER � � INS. <br /> TABLE <br /> 4 TANK WILL BE FILLED TIME) ON !; r' !�Y 1 _ _ .. +* <br /> i TANKEXTRA 5 GALS PRODUCT AVAILABLE FROMj. <br /> -G •3 r f' <br /> FILL-UP FILL UP TO BE ARRANGED BY MR. M"N2 1�� Q.f I��► PHONE D,F.)"t q.3-I` 7%", j <br /> CONTACT AT STORAGE TERMINAL IS MR. PHONE ) ---- I <br /> ti <br /> 5 NAME ADDRESS PHONE <br /> OUTSIDE <br /> CONTRACTORS <br /> 6 NAME AUTHORITY PHONE <br /> OFFICIALS a �. L C �' 1! O ljj <br /> TO BE <br /> CONTACTED <br /> PL-ull <br /> SPECIAL <br /> NOTES OR <br /> PRECAUTIONS <br /> a ALL TESTS WERE PERFORMED IN A(-.CORr)ANCE WITH PROCEDURES DESCRIBED IN SOILTEST'S <br /> INSTRUCTION! BOOK. CRITERIA .FOR TIGHTNESS IS ESTABLISHED BY NATIONAL FIRE PROTECTION <br /> ASSOCIATION',BULLETiN. N.F.P.A. X29. <br /> TANK(DENT TANK IS TANK IS LEAK RATE TEST DATE <br /> TEST I TIGHT NOT TIGHT G. P.H. y <br /> RESULTS --rj -0t. _I0_6006,1. ,.s,/ 036 <br /> 9 THIS CERTIFIES THAT THE TANKS DESCRIBED WERE TESTED BY THE UNDERSIGNED AND THAT THE STATED <br /> RESULTS REPRESENT THE TRUE STATE OF THE TANKS ON THIS DATE TO THE BEST OF MY KNOWLEDGE. <br /> CERTIFICATION SIGNED " issUE DATE <br /> t7- <br /> FOR (TEST COMPANY) um' <br /> ADDRESS '+ <br /> saux h <br /> N °� a STATE 11/E� II\fel`Ty .�1P I <br /> 4 <br /> i <br />