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as <br />LTst LTi <br />_ L <br />� 2a OPERATOR <br />Capacity .; <br />BnndJSupplar <br />Grade <br />„° <br />SteelJFibergloss ' <br />TaNerarte <br />s.. <br />3.',, REASON FOR <br />rK ARRANGEMENTS <br />�?%ii TEST <br />Terminal or other contact . <br />" <br />rrfGoa <br />for notice or inquiry + <br />- <br />n <br />10.` CONTRACTOR,:-. <br />'. <br />(Explain Fully), +� <br />p <br />e any other contractor <br />e. <br />� �, _ .d a • <br />_ . � .6; . <br />_ <br />ti <br />Comaam? of AKWomn ,�,-, ®ata , <br />Te"hons <br />1' <br />!'argon This . Telphone <br />Identify by f)rraCUOn <br />Capacity .; <br />BnndJSupplar <br />Grade <br />Approx. Age .: '•, <br />SteelJFibergloss ' <br />6.. TANK(S) INVOLVED <br />�-�` <br />hr. Da <br />Tanks to be filled to Arranged by <br />9.. FILL -UP <br />w .. <br />Noma Telepirom <br />rK ARRANGEMENTS <br />d -{ <br />t <br />Terminal or other contact . <br />" <br />rrfGoa <br />for notice or inquiry + <br />- <br />n <br />10.` CONTRACTOR,:-. <br />'. <br />; MECHANICS, <br />e any other contractor <br />h <br />OTHER.v <br />INFORMATION <br />OR REMARKS <br />Additional information on any items above. officials or other to he advised when testing is in progress or completed. Visitors or observers Present °- <br />taution=v , w; <br />..INSTALLATION <br />Cover <br />Fills., <br />Vents <br />Siphons <br />Pumps <br />& <br />s A to <br />O w <br />IA 71.7., <br />Mel <br />In, ? 1,016 <br />DATA <br />� (a <br />This Is to certify that these tank systems were tested on the date(s) shown. Those indicated as " Tiyhr' R?seB the a tarts established by <br />13. CERTIFICATION w- <br />ate Motional Fir. Protection Asoclation pamphlet 32IL <br />° Date <br />r� <br />North imide drivewa%I. <br />>'Conerm. Black Top.:' <br />•Sin. Titefal make. Oreo <br />- <br />- <br />Suction, Remota <br />Rear of seam. am <br />Egret• etc. <br />tubes. Remote Fias <br />Size. Manifoided <br />which tanks? <br />Mske ff known <br />xr 171z a.,- UNULMUMUNO <br />Is the water over the tanks <br />WATER <br />o.Ptn to the Wow table [) ra ❑ No " <br />t EC ..E .. _ <br />�-�` <br />hr. Da <br />Tanks to be filled to Arranged by <br />9.. FILL -UP <br />w .. <br />Noma Telepirom <br />rK ARRANGEMENTS <br />Extra Product to "toP off" and nun TSTT. Now and who to provide? Consider NO Lead. <br />d -{ <br />t <br />Terminal or other contact . <br />" <br />for notice or inquiry + <br />- <br />- - Company '" Nam* T*eohone <br />10.` CONTRACTOR,:-. <br />'. <br />; MECHANICS, <br />e any other contractor <br />involved <br />OTHER.v <br />INFORMATION <br />OR REMARKS <br />Additional information on any items above. officials or other to he advised when testing is in progress or completed. Visitors or observers Present °- <br />during test etc. <br />Tests was made on N» above tank systems in accordance with test protiedures proscribed for <br />12. TEST RESULTS <br />as detailed On 1111tilicived test charts with results as follows: <br />e <br />Tank Identification Tight Leakage Indicated Date Tested <br />1 <br />0/0 <br />In, ? 1,016 <br />� (a <br />This Is to certify that these tank systems were tested on the date(s) shown. Those indicated as " Tiyhr' R?seB the a tarts established by <br />13. CERTIFICATION w- <br />ate Motional Fir. Protection Asoclation pamphlet 32IL <br />° Date <br />r� <br />Serve No. of Thermal <br />Sema <br />