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DATA CHART FOR- TANK vYSTEM TIGHTNESS TEST <br />(EZY HEK) - <br />A. Tank Bot. to Grade p <br />B. Tank lop to Grade " <br />Send ort to: <br />C. Tank Diameter " <br />Client <br />nt <br />_ <br />D. Test Level above grade / " <br />Address <br />E. Depth of water in tankCity, <br />" <br />State <br />F. Depth for taking sample 3 " <br />Phone ( ) <br />Attn. <br />G. Temp. Probe depth (connector)_q 9 " <br />M <br />H. Test level to Tank Bot. / L D " <br />CERTIFICATION This 15 to certify that this tank system was tested <br />I. Groundwater above tank bottom m " <br />on date shown. Those indicated "Tignt- meet the chtena established <br />by the National Fire Pmteawn Association Pamphlet 329, <br />J. Product Pressure per 1" height [ gaPSI <br />Tank No. Z/) it- -_ <br />Test Pressure Formula <br />Tight K) 0 <br />r _ <br />1szQX�-( �3- X .036 _,-/ <br />) <br />Leakage Indicated + OR _ Rt�1Rlo <br />" , I NE-,: TEST <br />Technician v�y,rr, �n <br />Date Tested <br />PREiSURE <br />r_ <br />rn <br />n <br />z <br />M <br />D <br />7o <br />V* <br />M <br />M <br />.Inv <br />N <br />� <br />00 <br />