Laserfiche WebLink
Data#art for Tank System Ti ness Test <br />petro Tate <br />PLEASE PRINT TANK TESTER <br />1. <br />OWNER Property <br />13-E5^ G01.) OIL L} UD W K S- rL�E m A N <br />L_OD i CAL. <br />Tank(s) O <br />Name Address <br />Representative Telephone <br />Name Address <br />Representative Telephone <br />2. <br />OPERATOR <br />Name Address <br />Telephone <br />3. <br />REASON FOR <br />7rA'TS Tr_ A n)P.P)`7' <br />TEST <br />(Explain Fully) <br />4. <br />WHO REQUESTED <br />' <br />TEST AND WHEN <br />Name Title Company or Affiliation Date <br />Address <br />Telephone <br />5. <br />WHO IS PAYING <br />FOR THIS TEST? <br />Company, Agency or Individual Person Authorizing <br />Title Telephone <br />Billing Address City <br />State Zip <br />Attention of: Order No. Other Instructions <br />6. <br />TANK(S) INVOLVED <br />Identify by Direction <br />Capacity <br />Brand/Supplier <br />Grade <br />Approx. Age <br />Steel/ Fiberglass <br />Ndcrp <br />1200^0r� <br />—' <br />SI\i I r <br />1 Z 000 <br />1 ''.'rte S <br />.rn4I <br />20Ut`7 <br />7. <br />INSTALLATION <br />DATA <br />Location <br /><i'/`I�II/Ate <br />North inside driveway, <br />Rear of station, etc. <br />Cover <br />c j--rsTs <br />Concrete, Black Top, <br />Earth, etc. <br />Fills <br />/ _q <br />Size, Titefill make, Drop <br />tubes, Remote Fills <br />Vents <br />Size, Manifolded <br />Siphones <br />Which tanks? <br />Pumps <br />A.0 cm/ -04 <br />-7&1<: i?{pJ6 5 <br />Suction, Remote, <br />Make if known <br />8. <br />UNDERGROUND <br />WATER <br />Depth to the Water table <br />Is the water over the tank? <br />1:1 Yes No <br />9. <br />FILL -UP <br />ARRANGEMENTS <br />Tanks to be filled hr. Date Arranged by <br />Extra product to "top off" and run TSTT. How and who to provide? Consider NO Lead. <br />Name Telephone <br />Terminal or other contact <br />for notice or inquiry <br />Company <br />Name Telephone <br />10. <br />CONTRACTOR, <br />J,A��T' <br />MECHANICS, <br />any other contractor <br />involved <br />11. <br />OTHER <br />C=(,i ! '>r ., -T � . Q I c-ALl< <br />L 1✓ Atm 66 <br />INFORMATION <br />OR REMARKS <br />Additional information on any items above. Officials or others to be advised when testing is in progress or completed. Visitors or observers present <br />during test etc. <br />12. <br />TEST RESULTS <br />Tests were made on the above tank systems in accordance with test procedures prescribed for petro TttP <br />as detailed on attached test charts with results as follows: TANK TESTER <br />Tank Identification Tight Leakage Indicated Date Tested <br />tr" i'/ : � aJ •• %=�'1Lf� ("_ &S Lr 0 r<q GA <br />!L /1 Z Z ,.�, <br />C �.Y . r<� —d' �+Ml . F'r ` � '" �. • V 1 I lar n t.. F~9!'�.. i ? �, / 2'; <br />_ .. <br />;427'0- QPL.�-,EtJo - 2 56 6AL1h1_'*)7 <br />7. h9 <br />13. CERTIFICATION <br />Aura S <br />is to certify that these tank systems were tested on th"Tight" meet the criteria established by <br />Thise a is 's otliil"�it a nd cated as <br />the National Fire Protection Asociation Pamphlet 329. <br />— <br />— Testing Contractor or Company. By: Signature <br />Date <br />n d �T% n <br />•ierial Np. rf Thermal echnicians <br />Sensor ! / <br />