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' . AUG 22 '90 07: 514 � � P. 4/13 <br />Data Chart for Tank htn System Ti <br />Tightness Test <br />tSE PAINT <br />OWNER Fn;,nhy ❑ <br />;.r - ' � .— <br />r <br />.0 <br />TenR(H} ❑ <br />Name A40ress Zip <br />Re afien78live Talaphone <br />r,^! <br />Name Addrea9Zip <br />Repreaantalivn Tolephono <br />d'a• <br />OPERATQI <br />y,' • <br />- <br />Neme Addrnaa Yip <br />- -- -- <br />Tetaphone <br />TEST <br />(Explain Fully).WHO <br />REQUESTED <br />� tJC,&�wte- <br />TEST AND WHEN <br />Name info <br />Can+oany or Atnraliun Date <br />Address Zip <br />T814pnone <br />TANK INVOLVED <br />Identify by Direction <br />e-;, - � <br />capaclty BrandlSuppriae Brace Appro;r. Age <br />C �3 k <br />5160IAZr Ieae <br />U" additional linea <br />for tanks <br />�- <br />---a <br />--. <br />manifoidod <br />INSTALLAI11UN <br />DATA <br />1-666110n <br />t'i <br />North inside driveway, <br />Rear of illation, etc. <br />COvarf16e�(tl vents Siprwnez <br />I<' ,�--t' T �� As00..IC�_ <br />Concrete, Black Top, $ind, Titelill make Drop . <br />Earth, etc. tubas. Remote Fill} It yze, Mamfoldeo Whlcn tanks? <br />Pump; <br />j �• <br />Suctio Qmo� <br />Make if known <br />UNDERGROUND�}i <br />WATER <br />Depth 10 the water tante from grade / <br />Is Ine�w'alar overt in,($+1ana't <br />t J yes o <br />FI6LL-U��,Pl+C�t r IY( <br />ARRANGEMENTS S <br />Tenks to be filled _ hr, Ditto Arrangeo W —.—..._ <br />Extra product t0 'ivp off, lino run tank toitor. How and who to prOvioo? Con;iclgr No Laad <br />Name TeledhOne <br />Terminal or othor contact <br />160 notice Of inquiry <br />—J <br />Company <br />Hama 7atepnona <br />CONTRACTOR, <br />MECHANICS, <br />Any Other contractor <br />--_-- <br />involved <br />OTHERta14.5INFORMATION <br />l} <br />OR REMARKS <br />OR <br />Atlo+Uonel IMOfmaGon on Any {lams OW10 Offlelalf _ ar Wars to 0o adv{}oil when pra}am dwmp teat, et C.} w <br />TEST METHOD <br />PETRO TITI <br />®PETRO COMP <br />❑ QUICK CHECK 2000 <br />�. TEST RESULTS <br />Testa weft mode on the above tank system, In accordance with test procedures <br />as detailed on attached test charts with results as follows: <br />Tank Identif4carion Tight Leakage Indicated <br />prescribed for <br />Date Tealed <br />SENSOR <br />CEATIFICATiDN <br />Deti, y <br />5*rtaO.z TT,armaf <br />Sensor <br />13. CONTRACTOR CERTIFICATION <br />Technicians <br />Ara 9 <br />� j[IGenl9icnti6n Ir t �� v � ""tea-` �-- <br />Conitloatlon a <br />T 4 Ing. Contractor lir Company. By: Sign re <br />-}�.-%Addraaa <br />MOW <br />