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Work Order: 2255576 <br />11 <br />Tanknology Inc. 8501 N. MoPac Expressway, Suite 400, Austin, Texas 78759 <br />For ( •'r' tir.al).iii!'in t;f.;,xb: <br />H -h it r.'C <br />d:rit:rfri!-'-* •r!, i ::r::tNlr.-G �.:1r fG:;nrl 4 liv:' (:nil:, <br />Ch"p/cr 16,1-ih'l.:;wt J. 111kd '3. f :diira'ni:: (irlg ty lfii7:Lb:.nn: <br />'Ibis fbrrn mtssr be nxcl to dN-Lak it kstim- and rmicink of nuudtoring cgniplxat. A SA:4.decr- cSati n or ,•(kart m;rst he <br />p. ll _each Inrn6tn19rld U -'-tem. Control Ravel by Ille txlll:62-1 <br />wlui pet Purms file wl-•Ii . A Copy ofthis f6rn must l.K Pn:v(ded W <br />the t2n.4 sysre m on ne0opemot.. Tlu: owncrloperalur must m:htnit a copy of this fc.-In to the kn;A ag�ary regaLvins LIS I' sysrellts <br />within 30 clays ofteat (late. <br />A- Gencl-Al information <br />la.:li3y Al:nite' <br />�yy ��� <br />nils. No.: <br />�T�.,%T..i:OC <br />Sire?.ddress: 07-- 6th. �4MtMrk= <br />_ <br />iiw <br />Facility Contact Verma: _ q4e-* <br />_ Coatatt phone No.; f Z9)9 <br />MAkeiUelik:1 efMon(tadna System: <br />'jzs--s 54, _ (Tote oiTwting;Serv'tcittg: 3 : 3 t� <br />— <br />S. JuveutGryof Equipment Teeteti.ICertiBed <br />CA�YLtkrn 194 f,ox4 tr101ilralr.. Cask ttaa 'tef!Yrriexd: <br />'Tank fl): 'gam 6�7 <br />')1mk 1iD: �e�S�_ 4 <br />I�ln-TntN: Ciuugiog PtvGr. Mrulel: p11er-TmkGauging Rnbr.— <br />E'�Artnular Slvo:e w Vau1i Sensor. Moticl: T <br />$ Amndar S or Ywl[ Sen_me Model: <br />_ <br />i1Pi(+inRSump:Trcrx.hScatrx'{s). MndeL• o <br />_ <br />PJPip'mta,SlRrrp:TrxuchSr�,JR .aGs). Modc:t: <br />O Fill S(unpSensnitsk Nhe1c1: <br />O F'ill5umP SeRsur(s}. Model: <br />y_ _ <br />Mlti1liNNr :II ].IRC I.blk ra'Ir:6M'. Mtxkl: srn•/?� <br />� <br />_ _ <br />F�MCCABnllid [,opal I.Gak t�CC�L A'hRiCl:�?06Ty^i <br />O EFelxronic tine E.c,t (hteutur. Model: � <br />J ElecNudc Line Leak I'?etelxor. Murkl; <br />❑ Tank Or�lt ! High -Level Srnsx, Mode]: <br />U TIaIL Oia:rfill / F tips-i.evel Beasts. Mnrkl: <br />L7 Other (s eciFy a ui t pc and mods in Seedat Eon Paec 2 . <br />U fkbet (9ltrcif vi tsar y e and nisMel in Seconal E ou Pn - 2)• <br />9'ank ilii <br />'!"sok tfF. <br />¢l fn -Tank Gnugil.g. Prr,he. Model: /N'Igin t ' -- <br />U (n-Tsnk Gwt(<ing t'ml,e_ Mukt: '- <br />8( Auuulm'Space or Vauh Seuaw. Model: <br />O Asoeulm Space ar Vault Sensor. Model: <br />$ Piping Suxtyt 1 Tlxta3r Snuur(sk M(xkf: <br />O Piping Scalp /Trach SeosaaisL Mak,: --_ <br />O Fil! Sung, Sa>rortsL Model: <br />❑Fill Sump Smtarr(.$)- Model: <br />$L A•truhanteal Lfne IRakllttecior. A.bdat: 571��_ <br />i7 Me.Lurliral Lila i.rrk ik:rccAn, Model: <br />CI Efrfironie Tits t.enk Retrgor. Model: <br />U t!ketrolsic i.inc Lad( Dtreetsx- Mndcl: <br />OTank (TvxrtiFl!ftigl,-F.evxlSenmr. Mtakl: <br />OTuokOmf(![lt{igk-l.evelSeurrr..i4r,rtet: <br />❑ Otlaxr (s eciEy atW Iswrkl bt Searof F nr1 P • 11. <br />_ <br />� L Gtlrr { I:iF t and m«iet n Seakm E an Paas 2). <br />Pz <br />Dl.+prnser til: lam. <br />Di�errxrlD; St: trJ p/� <br />O rlisfxnser Containment Satsur(a). Atndei: <br />q Ogprrotr Cnraaioment Stlssais>. MudeF. � <br />S7uar Va1.Ka>- <br />_ <br />.lj.5lear Y(dvc(s► <br />Ui mer C.xu:tinmcY Float(s) aruf Chain s1. <br />�R'1(Dis eeesrr Containment r•7nRt{.<) and Ct#ti (s). <br />Dispenser ID; t <br />Diapern[r [D; 7 S r,✓ �� <br />U niglenscr Contaimncm Seswex{sl. Model: <br />... <br />Uesperser Cmuainntent Srussot(s1_ MOdrd: <br />. <br />kSheorYalve(sj.irmraNPluat(s) <br />and Clt�MsL <br />8erCent-•enmeM Float{s)and ChailXsb <br />_._DLspert6erIll:aimnadticnwxts).AFnid:❑{]Sfsearrtn'TnnFksfllslandt7>ais{s). <br />EE22) <br />ODisy+enserComailarrcalFlue <br />alidWWlilly unsmar5'tn(J:vordUpens'.1%. rpylhi;:l:x:rl.larluk:info'Rlinnforawryts:Y.anddispeasetatthefi-lay . <br />Cerfiftratiun - I eertirr that the equi)anent Iskatiso in thi+ dacumeat was htspetted/sw'r '"1 is aeewn4aaee with the <br />nlanufaehrms' ERideik". Attached to this (dtiRMOOa io {Rfvrmatlsa (e.g, manufdrfarell thetkllw) necesa q to verify that thin <br />information is eorreet nod a Piot Plan showhtg the layout of mot No�pn^ rent. For any equi lm1 eopahk- of generating anrh <br />reprlrts, I have aim nftaedrd a the <br />ropy of export: (dr¢'k ah rJxrt <br />Te clui clan Name (prod): <br />a/yNy); Hil s1 a Alarm histnl'y report <br />CCrfl(ICatiMl No.: -_ <br />rec at �,a4 33a. o r <br />IAL'�nY_NO.;- <br />TestingC:nupauyNamt::�•g-r• <br />PhaltcNu.:i;�t)�_j��p/f,7 <br />Silo Addscs: 44'ZOZr iA%��14" .._ <br />DweofTesiir--gr9rv,.,-i.g--.✓3 % !Q8 <br />• Paze i af3 flAtil <br />Monitoring system Certificild m <br />D. PesttltsttfTeslingiServfcing <br />Tanknology Inc. 8501 N. MoPac Expressway, Suite 400, Austin, Texas 78759 <br />[(sluns)Chau((yl. ' <br />Tanknology Inc. 8501 N. MoPac Expressway, Suite 400, Austin, Texas 78759 <br />