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ORKSIIEET FOR SUBMITTAL TO GOVERNMENTAL AGENCY <br /> OWNER/OPT R, SITE AD RF f" t= <br /> CITY—, <br /> COUNTY s c ��. . <br /> f ,_J <br /> MIAILING AI)DRE S 7.77.7:, <br /> SITE AGENT TELEPHONE <br /> ARRIVED TEST 91 TAPI C 4DICT <br /> 12 <br /> DATPBTIDE STORM =TS FILLS �"" T LEVEL A ARRIVA `` N01E9 OWN TOP OF FILL NOPHNAL TANK 912 <br /> P e <br /> TANK VITTAP® X. A. r . PILL 91217 E 1. FILL AIN T TYPR J _ <br /> APT sK4TtTT AT tDEG. F. ® APIC 'PITY 0 160F • COEFFICIENT OF EXP S1 01 COP O <br /> T �®/ --- �- <br /> __ 1 ® F <br /> VWSARLP VENTING APPEARSTO EP AT.- FILL END ILL <br /> d NO® HAS BU E• UNKNOWN. HAS A 9ALL GINCK, tPR <br /> VWSARLR VAPOR TRAPS TO OR RLPD; ®ALL aIPCKS, NAINATS. 0 <br /> P/tASE It VAPOR MUMBRY STSTPN TYPE: 9ALAI ASPIRI ASSISTED LONG RtRt 1011.13 NANMOLDEM<N fPR - - <br /> PSPtPtNP. STST® S 1 INP P P .� NODL — — — <br /> f '---� PIPE Lt TEAK nP.TF. RC p <br /> CWIARrFO TANK 9t2P ` fSTI TPO LdFaR QUANTITY P A 0 TO F 0 tiTrPM <br /> TS <br /> TPN GALLONS TOTAL <br /> MIR IENT KEATIIPR C€rsDITl S! TEWFRA71TRa FRPTF9T® <br /> P( T TESL t Y dNINC CLPAIEDY MINDY NtcatT OTfrtgR _ <br /> SYSTEM F < M _ <br /> IW .1 PSI PSI 69 MAINTAINED ON TANK R N DURING TEST VERIOIL ®i <br /> ® A. GRADE TO TANK lmiv4 <br /> 2, GPM TO TANK TOP <br /> C. TARK DIA T!R <br /> 7777 777 <br /> a / D. TEST LEVEL APOVE GRADE <br /> g dS. EXTERNAL GRO tD KATER MOVE TANK <br /> f ® In. X .0351 PSI • <br /> F. TOP OF FILL 'M PROD. AT ARRIVAL Pd <br /> C. 70P OF FILL TO TOP OF TANK <br /> H- TFM Lll 'TO BOTTOM 07 TAPIR � f <br /> RATTR IN51- FSI PER INuW OF provixf % <br /> TANK . <br /> ST lIEIQtT PRESSURE FO A <br /> c 77 <br /> X - r <br /> W1. FSI E. P9I NFF r r5 6� <br /> R1MEAUS <br /> 711E FINAL TEST PERIOD AS SEIOWN ON THE A'I"rAC IED COM11(f7'rut GE:NI T'ED DATA RE,FLE:CIS1 A 1 <br /> I,Oa� " CHAIN OF:,Vj <br /> GALLONS PER HOUR, WITH CONFIDENCE LEVEL OF (of'll. <br /> USING '111E IIORNER EZY CIIEiK II MtEi'11101) OF TESTING THE RES111,TS AS SHOWN ARE Vnlri71r / <br /> NOT WITHIN 11113. STATE OF CALIFORNIA AND VIF NI"PA 329 GUID LINES OF A MIA IMR1 LOSS Olt <br /> CAIN 01° .05 GALLONS PER II UR FOR A T SYSTEM TO Or- CONSIDERI'D TIGIIT. <br /> INTEGRITY TANK TESTING SYSTEtIS, INC. 166 E K WEST (:I, <br /> STOCKT'ON, CA 95206 (209) 466-80 6 or (800) 262-8378 <br /> . _ <br /> CERTIFIED TETHER iz6e4d <br /> ° T° DATE <br /> s <br /> • <br />