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Cover Fins Vents Siphones .J.,r <br />6. INSTALLATION� � �/rr �ij // ` ,�� lCy <br />DATA 1�1�7rle <br />� 7j`' �/ /tel 6� <br />North inside driveway, Concrete, Black Top, Size. Titefill make, Drop Suction, Remote. <br />Rear of station, etc. Earth, etc. tubes, Remote Fills Size. Manifolded Which tanks? Make it known <br />7. UNDERGROUND �/'// [// Is the water over the tank? <br />WATER Depth to the water table from%` / v 11 Yes <br />.L�1 No <br />Tanks to be tilted hr. �ff to Arranged by <br />8. FILL -UP Name Telephone <br />ARRANGEMENTS Extra product to 'lop off' and run tank tester. How and who to provide? Consider NO Lead. <br />9. CONTRACTOR, <br />MECHANICS, <br />any other contractor <br />Involved <br />10. OTHER <br />INFORMATION <br />OR REMARKS <br />11. TEST METHOD <br />11a. TEST RESULTS <br />Terminal or other contact <br />for notice or Inquiry _ <br />Company <br />Name <br />/r /ti <br />Additional information on any items above. Officials or others to be advised when testing is in progress or completed. Visitors or observers present during test, etc. <br />PETRO TIT ❑ PETRO COMP ❑ QUICK CHECK 2000 <br />Tests were made on the above to* systems In accordance with test procedures Prewilbed for <br />as detailed on attached hat charts with results as follows: <br />Tank Identill tion Tight or Net Volume Change Per flour Date Tested <br />12. SENSOR 13. CONTRACTOR CERTIFICATION TR G!E INC. Of SACRAMENM <br />CE TI ICA ION_ _ hn P.O. BOX 231067 <br />ENM. 95823.1067 <br />An <br />Vesting Contractor or Company. By: Signature <br />SOA&I No. of Thermal Certifkxton s <br />Sensor //17y <br />r" �J— / <br />Address <br />Certification a PN6627 <br />*ata <br />Chart for Tank Sys Skin Tightness <br />PLEASE PRINT <br />1. OWNER Property ❑ <br />Tank(ti) ❑ <br />rim // / ! <br />Address Zip Representative <br />Telephone <br />Name/ <br />Address Zip Representative <br />phone <br />2. OPERATOR <br />Nara <br />® Address zip <br />Tateptione <br />3. REASON FOR <br />TEST <br />(Explain Fully) <br />4. WHO REQUESTED <br />I <br />TEST AND WHEN <br />Na"" <br />Title Company or Affiliation <br />Dale <br />Address Zip <br />Telephone <br />5. TANK INVOLVED <br />tdenti DY Direction <br />Capacity <br />Brand ppiier Grade <br />Approx. Age <br />Staaf/F <br />Use additional lines <br />for manifoided tanks <br />Cover Fins Vents Siphones .J.,r <br />6. INSTALLATION� � �/rr �ij // ` ,�� lCy <br />DATA 1�1�7rle <br />� 7j`' �/ /tel 6� <br />North inside driveway, Concrete, Black Top, Size. Titefill make, Drop Suction, Remote. <br />Rear of station, etc. Earth, etc. tubes, Remote Fills Size. Manifolded Which tanks? Make it known <br />7. UNDERGROUND �/'// [// Is the water over the tank? <br />WATER Depth to the water table from%` / v 11 Yes <br />.L�1 No <br />Tanks to be tilted hr. �ff to Arranged by <br />8. FILL -UP Name Telephone <br />ARRANGEMENTS Extra product to 'lop off' and run tank tester. How and who to provide? Consider NO Lead. <br />9. CONTRACTOR, <br />MECHANICS, <br />any other contractor <br />Involved <br />10. OTHER <br />INFORMATION <br />OR REMARKS <br />11. TEST METHOD <br />11a. TEST RESULTS <br />Terminal or other contact <br />for notice or Inquiry _ <br />Company <br />Name <br />/r /ti <br />Additional information on any items above. Officials or others to be advised when testing is in progress or completed. Visitors or observers present during test, etc. <br />PETRO TIT ❑ PETRO COMP ❑ QUICK CHECK 2000 <br />Tests were made on the above to* systems In accordance with test procedures Prewilbed for <br />as detailed on attached hat charts with results as follows: <br />Tank Identill tion Tight or Net Volume Change Per flour Date Tested <br />12. SENSOR 13. CONTRACTOR CERTIFICATION TR G!E INC. Of SACRAMENM <br />CE TI ICA ION_ _ hn P.O. BOX 231067 <br />ENM. 95823.1067 <br />An <br />Vesting Contractor or Company. By: Signature <br />SOA&I No. of Thermal Certifkxton s <br />Sensor //17y <br />r" �J— / <br />Address <br />Certification a PN6627 <br />