Laserfiche WebLink
WORKSHEET FOR SUBMITTAL T9 GOVERNMENTAL AGENCY <br /> 'OWNER/OPERATOR 1 <br /> YE ADDRESS /(a v� � J I/ <br /> CITY r Z1 `'� <br /> COUNTY <br /> MAILING ADDRESS <br /> SITE AGENT <br /> TELEPHONE "Cl <br /> ARRIVED TEST ROM TANK LOCATION <br /> ® PRODUCT l/ <br /> BATE/TINE STORAGE FILL E�p / qg ODUCT LEVEL AT ARRIVAL INCTIES BELOW TOP OF FILL NOMINAL TANK SIZE <br /> TANK MATERIAL APPROX. TANK YRS. FILLS IZE/TYPE OERFILL CONTAImmw <br /> -gp- T V <br /> API GRAVITY.53�- _AT !a bEG. F. API GRAVITY OF @ 60F <br /> COEFFIC%ENT OF EXPANSION OF ,000 - COE <br /> VISA13LE VENTING APPREARS TO BE AT, F <br /> ILL OSITE <br /> HAS BURP TUBE, NAS BALL CHECK, UNKNOWN, OTRM <br /> VISABLE VAPOR TRAPS TO BE BLED.- BALL CHECKS, MANWAYS, RETURN LINES, OTHER <br /> PHASE II VAPOR RECOVERY SYSTEM- II CED ASPIRATOR ASSISTED, LON <br /> HELLS, MANIFOLDEb, NONE, OTHER <br /> PUMP INC SYSTEM SUC7_ , TURBINE MAKE � �y --- '/� <br /> PIPEr�-LINE LEAK.Detectors YES. OT AI'PLIC <br /> CHARTED SIZE <br /> _Z2_ EST.EST. LINE QUANTYTYZ47 PRODUCT ADDED TO FLOOD SYSTEM > SYSYEM TORAL GALLONAGE ' <br /> AMBIENT CONDI T S: TEMPS PREYES�� PO TE <br /> OUDY, RAINING, WINDY, NICHT OMER <br /> .4 PSI DRO -HOURS TEST TOO S� <br /> 0 URS PSI TO BE MAINTAINED ON TANK BOTTOM DURING TEST PERYOD - <br /> i FSI <br /> 01 <br /> A. GRADE To TANK BUTTON <br /> 0 , B. GRADE TO TANK TOP <br /> 6.Pi9AE C. TANK DIAMETER _ 7 <br /> D. TEST LEVEL ABOVE CRE �. <br /> ` G LZ ST^L 7�� AD <br /> E. EXTERNAL CROUND MATER ABOVE TANK <br /> F /711-z— <br /> 1 -z + BOT m IN. H .0361 PSI - <br /> 14�1 f J F. TOP OF FILL TO P900• AT ARRIVAL / <br /> A C. TOP OF FILL TO TOP OF TANK <br /> N. TEST:129EL•.TO'BOTTON OF TANK / ^ <br /> NATER INpte c•�L_ PSI,PER INCH OF PRODUCTvu <br /> TALAR •./ M <br /> E TEST HEIGHT PRESSURE FORMULA <br /> REPIARKS: "� _ N. PSI E. PSH - NET PSI <br /> 12: v ` rf? <br /> eI sop <br /> RES, S <br /> THE FIN L TEST P IOD flS SHOW ON THEIATTACHED COMPUTER GENERATED DATA REFLECTS A <br /> LOSS / G _ WITH#• A 99% CONFIDENCE LEVEL OF +/- <br /> gph. <br /> THE HORNER E II METHOD COMPLIES WITH EPA AND THE STATE OF CALIFORNIA PERFORMANCE STANDARD OF 0.05 CPR <br /> FOR TANKRITY YR (S CTION 2643 CALIFORNIA CODE OF REGULATIONS) BASED UPON THIS STANDARD THE RESULT <br /> SHOWN ABOVIN GDOES INDICATE AN UNAUTHORIZED RELEASE EQUAL TO OR GREATER THAN THE 0.05 OPH STANDARD. <br /> INTEGRITY TANK TESTING SER CES, P.O.BOX 691376 STOCKTON, CALIFORNIA, <br /> 95269 (209) 474_1375 or (800 262 -8378 <br /> CERTIFYED TESTER STATE LICENSE <br /> .) TEST DATE /9 <br />