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4%ata <br />Chart for tTightness <br />PLEASE PRINT <br />1. OWNER property ❑ <br />' <br />Addition anms�Officials or others to be advised when testing is in progress or Completed. Visitors or observers present during test, etc. <br />PETRO TITC2Z— <br />❑ PETRO COMP <br />Tank($) ❑ <br />N <br />Address Zip Representative <br />Telephone <br />Ten Identification Tight <br />Name <br />Address Zip Representative <br />Telepho <br />2. OPERATOR <br />Name ® <br />Ad • Zip <br />Telephone <br />3. REASON FOR <br />TRIANGLE INC. OF SACRAMENTO <br />% <br />P.O. BOX 231067 <br />TEST <br />SACRAMENT OU, CA 95823-10 <br />ZCw�flffc�ntfonD <br />Testing Contractor or Company. By: Sgnature <br />2 0—le9ld <br />(Explain Fully) <br />Certification 0 <br />PN6827 <br />4. WHO REQUESTED <br />TEST AND WHEN <br />Nanta <br />Title <br />Company or Affiliation <br />Date <br />Address Zip <br />Telephone <br />5. TANK INVOLVED <br />by Directions, Capacity � <br />Gt�/7 D <br />Brend/Supplier <br />T/99 <br />Gr � Approx. Age <br />St�l/FiberOl� <br />, r <br />Use additional litres <br />for manifolded tanks <br />6. INSTALLATION <br />DATA <br />7. UNDERGROUND <br />WATER <br />8. FILL -UP <br />ARRANGEMENTS <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 />12. SENSOR <br />_CERjIFIC TION <br />7.I No. of Thermal <br />Sensor <br />LOG015130 Cover Fills Vents Siphones Pu <br />Z; <br />Ir A - � C13 <br />(5/7� <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 If known <br />�/�% /����,v) _ Is the water over the tank? <br />Depth to the water table from gratia f/" `� l " ' ❑Yes ' No <br />�y _� <br />Tanks to be tilled fir. ? _//_ Oeste Arranged by <br />Name Telephone <br />Extra product to 'lop off' and run tank tester. How and who to provide? Consider NO Lead. <br />Terminal Or Other contact A-,) <br />�' / ® /� ) <br />for notice or inquiry , y � <br />Company Name Telephone <br />i <br />Addition anms�Officials or others to be advised when testing is in progress or Completed. Visitors or observers present during test, etc. <br />PETRO TITC2Z— <br />❑ PETRO COMP <br />❑ QUICK CHECK 2000 <br />Tests were mate on the above tank systems In accordance with lest procedures prescribed for <br />as detailed on attached <br />test charts with results as follows: <br />Ten Identification Tight <br />Not volume Change Per Hour Date Tesfbd <br />13. CONTRACTOR CERTIFICATION <br />TRIANGLE INC. OF SACRAMENTO <br />Icla <br />P.O. BOX 231067 <br />SACRAMENT OU, CA 95823-10 <br />ZCw�flffc�ntfonD <br />Testing Contractor or Company. By: Sgnature <br />2 0—le9ld <br />Address <br />. <br />Certification 0 <br />PN6827 <br />