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L <br />UG <br />I <br />TECHNOLOGY FOR TANKS —> <br />ANO THEIR ENVIRONMENT - - <br />.6 <br />Owner Ct, ear c" <br />Invoice Name/Address <br />Site Name/Address -,7-3(- At N /_ A/ <br />TANKS <br />LINES-,- , <br />Leak Det <br />S <br />SeeSee <br />For <br />Loc <br />Tank <br />Product <br />Tank <br />Capacity <br />Tank Dipped Dipped Probe <br />Dia. & Water Product Water <br />Material Level Level Level <br />ST/ ■ ■ ■ <br />FRP/ START START START <br />Lined END END END <br />Ullage <br />Water Bubble Air <br />Ingress Ingress Ingress TANK <br />Detected Detected Detected : ■ <br />■ ■ ■ Tight <br />or <br />Yes/No Yes/No Yes/No Fail <br />Line # <br />Line <br />Material <br />■ <br />ST/ <br />FRP <br />Line <br />Delivery <br />Syst. Type <br />■ <br />PS/SS/GS <br />LINE <br />TEST <br />■ <br />START <br />TIME <br />LINE <br />TEST <br />■ <br />END <br />TIME <br />Final <br />Leak <br />Rate <br />■ <br />GPH <br />LINE <br />■ <br />Tight <br />or <br />Fail <br />Exist <br />LD(s) <br />Pass/ <br />Fail/ <br />or <br />NONE <br />NEW <br />LD(s) <br />Tested <br />& <br />PASS <br />w� <br />i <br />f <br />c> <br />DOStart <br />-Diamet Ai <br />f S" t/ „ Z t <br />-T <br />, <br />-D <br />s v <br />Ta <br />I <br />a <br />�./,v <br />IMz'IVY <br />r �q ,MRN <br />47,777 <br />All <br />at a ]T o ill at ump <br />Start Time: C! Test: . tp 7C�M <br />Vn <br />n Ti !J — • ZO e ILC nc inometerFifae , , <br />rcent o 1 at ump <br />Time: Ttme of Test Mf .: <br />an roe Inclinometer <br />End Time: Test I Ent : Der : <br />iameter A-, <br />D lam <br />x <br />{, s <br />r �,. <br />t �'� <br />" <br />c. <br />sten canto I at' Mfg.: <br />Start Time: Time of Test • <br />�r <br />Tank Probenc urometer <br />n T Ent r <br />Diameter d 2 <br />mol <br />n „ „ <br />„�... <br />wi <br />atenaPercent of "if at Pump <br />Start Time: Time of Test: Mfg.: <br />- r0Inc Inometer <br />d Ti T I n r <br />lameter T >: <br />s + <br />k <br />3 <br />5` '•ter <br />O.<. <br />. <br />` <br />aten t o at ump <br />Start Time: Time of Test <br />an inclinometer <br />End Time; I r <br />z:^10 <br />a�*?s. <br />;.End <br />ti��`• <br />.. <br />MR <br />�, <br />m <br />atena t o 1 a .,Pump <br />Start Time: Time of Test: Mf <br />anProoed,, nc lnottteter <br />Time: <br />TANKNOLOGY Region: Unit # State Lia # <br />NOTE: Original VacuTect Data recordings are reviewed by Tanknology's Audit Control Department and maintained on file. <br />TAK-01 <br />TANKS and LINES Tested to CFR -40 Parts <br />280-281 & NFPA 329 Spec's. <br />Other: <br />Exist LD SN/MDL/MFG: .. <br />New LD SN/MDVMFG: y_ I <br />LINE TEST PSI <br />Dispenser Shear Shear Valves <br />Operate es/no <br />Exist LO SN/MDL/MFG: <br />New LO SN/MDL/MFG' <br />LINE TEST PSI <br />Dispenser Shear valves f <br />Operate es/no <br />Exist LD SN/MDL/MFG: j <br />hrew LD SN/MDL/MFG: { <br />LINE TEST PSI <br />Dispenser Shear Valves <br />Operate es/no <br />Exist LD SN/MDL/MFG: t <br />i <br />New LD SN/MDL/MFG: <br />LINE TEST PSI { <br />Dispenser Shear Valves <br />Operate Ives/no)- { <br />Exist LO SN/MDL/MFG: <br />s <br />New LD SN/MDL/MFG: <br />LINE TEST PSC <br />Dispenser Shear Valves I <br />Operate es/no <br />Exist LD SN/MDL/MFG <br />New LD SN/MDL/MFG: . <br />LINE TEST PSI: '. <br />Dispenser Shear Valves -- <br />rate smo <br />Tanknology Corporation international <br />State: 5225 Hollister St., Houston,TX 77040 <br />(800) 888-8,563 FAX (713) 690-2255 <br />