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888 N.FARMERSVILLE BLVD. <br /> ~ P.O.BOX 205 JIM T <br /> TEST SITE LAY T FARMERSVILLE,CA 93223.0205 S A�T A �T ENVIRONMENT* <br /> 22 ----- - (209)7473210 t�.1V .C�1VCO. <br /> AINLAY TANK `TEGRITY TESTERT"" FIELD TEST DATA <br /> • 1 NAME ADDRESS PHONE <br /> r ASF <br /> TANK C1 <br /> OPERATOR <br /> c �5tio� <br /> 2 IDENTIFICATION CAPACITY—GALS. MANUFACTURER STEEL/F18RGLS. AGE YRS. <br /> .. �� -•O`- �.o 069 �. •� � b <br /> TANKS TO ®0l <br /> BE TESTED <br /> 3 WATER DISTANCE FROM GRADE TO WATER INS. <br /> TABLE <br /> 4 TANK WILL BE FILLED NIN (TIME) ON Cf 1 <br /> EXTRA 5 GALS PRODUCT AVAILABLE FROM <br /> TANK PHONE( ) <br /> } FILL-UP FILL UP TO BE ARRANGED BY MR. <br /> _ CONTACT AT STORAGE TERMINAL IS MR. PHONE( ) <br /> C�G 5 NAME ADDRESS PHONE <br /> OUTSIDE <br /> 3i`W71 <br /> CONTRACTORS _. <br /> / 6 NAME AUTHORITY PHONE <br /> 23 <br /> OFFICIALS M .. <br /> I TEST 1: TANK DIMENSIONS TEST 2: TANK DIMENSIONSy <br /> TO BE <br /> CONTACTED <br /> i <br /> I I EXTENSION I I EXTENSION 7 <br /> I I PIPE I i PIPE SPECIAL <br /> I i I I <br /> i i I NOTES OR <br /> PRECAUTIONS <br /> GRADE i GRADE j <br /> I I i I 8 ALL TESTS WERE PERFORMED IN ACCORDANCE WITH PROCEDURES DESCRIBED IN SOILTEST's <br /> (a1 INSTRUCTION BOOK. CRITERIA FOR TIGHTNESS IS ESTABLISHED BY NATIONAL FIRE PROTECTIOP- <br /> (c) <br /> �= ASSOCIATION BULLETIN. N.F.P.A. 329. <br /> TANK 1DENT TANK IS TANK IS LEAK RATE TEST DATE <br /> TEST TIGHT NOT TIGHT G.P.H. <br /> -�-' <br /> RESULTS `�"n- 4\ F .0 3 �-- -Q 1 <br /> (e) (bl ..e lel (bl .— .r(� (� <br /> �s 7 <br /> (d) t ldl - <br /> WATER TABLE WATER TABLE <br /> 9 THIS CERTIFIES THAT THE TANKS DESCRIBED WERE TESTED BY THE UNDERSIGNED AND THAT THE STATE <br /> - -- <br /> r _ — RESULTS REPRESENT THE TRUE STATE OF THE TANKS ON THIS DATE TO THE BEST OF MY KNOWLEDGE. <br /> - <br /> (h) s (h) ✓� _ <br /> -- CERT1Fi,ATE N TEVE YOUNG <br /> � <br /> CERTIFICATION SIGNED ISSUE DATE <br /> I io FOR (TEST COMPANY) <br /> J y > ADDRESS <br /> ( -- TANK(DENT. y TANK(DENT. O ¢ <br /> ZIP <br /> STATE <br /> ,I <br />-- a F <br />