Laserfiche WebLink
TANK 6I ata fSart for Tank System Ti ess Test <br />i1. <br />1111A YNE <br />wousteas WC <br />_ro Tatem <br />TANK TESTER <br />1. <br />OWNER property k6 <br />Mobil Oil C o r p o ration 612 S. F 1 ower_L.A. <br />CA. 90017 ( 213) 683-5985 <br />Tank(s) <br />Name Address <br />Representative Telephone <br />Name Address <br />Representative Telephone <br />2 <br />T MT(y <br />LOCAMN <br />NameD Address <br />Teiephone <br />3. <br />REASON FORess <br />Test <br />TEST <br />(Explain Fully) <br />4. <br />WHO REQUESTED <br />Kurt Fischer Fn ineer <br />Mobil Oil Co ration 3-24-86 <br />TEST AND WHEN <br />Name <br />S. Flower St. L.A. �. Title 17 <br />83 5985 Date <br />Company or Affilj2f ` 683-5985 <br />/\c Z1l,3j/l W.J" 7W <br />Address <br />Telephone <br />5. <br />WHO IS PAYING <br />Nbbil Oil Cgtion <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 DLirection <br />ES 7 <br />Capacity <br />a J/o <br />Bran /Supplier <br />D r SF <br />Grade <br />Approx. Age <br />Steel/fiberglass <br />aMSS <br />7. <br />INSTALLATION <br />DATA <br />Location <br />North inside driveway. <br />Rear of station. etc. <br />Cover <br />Concrete, Black Top, <br />Earth, etc. <br />Fills <br />Size, Titefill make, Drop <br />tubes, Remote Fills <br />Vents <br />Size, Manifolded <br />Siphones <br />Which tanks? <br />Pumps <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 />Name Telephone <br />Extra product to "top off" and run TSTT. How and who to provide? Consider NO Lead. <br />Terminal or other contact <br />for notice or inquiry <br />Company <br />Name Telephone <br />10. <br />CONTRACTOR, <br />A & A Tank Testing <br />MECHANICS, <br />.5630 District Blvd. — Suite #103 <br />any other contractor <br />Bakersfield CA. 93313 <br />involved <br />11. <br />OTHER <br />INFORMATION <br />. <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.pressnt <br />during test etc. <br />12. <br />TEST RESULTS <br />Tests were made on the above tank systems in accordance with test procedures <br />as detailed on attached test charts with results as follows: <br />Tank Identificatio Tight Leakage Indicated <br />prescribed for P—leko T t—e <br />EA-IESTIR <br />Date Tested <br />13. CERTIFICATION <br />Date <br />AS43 <br />Serial No. of Thermal <br />Sensor <br />This is to certify that these tank systems were tested on the dates) shown. Those indicated as <br />the is <br />Fire Protection Asociation Pamphlet 329. <br />Technicians <br />ria establ' ed by <br />Testing'Contractor or CoMpanVt3yo, Signature <br />5630 District Blvd. — Suite #103,Maexsfield, CA. 93313 <br />