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247 Ro. - �tEN N E_ •A O. <br /> IVANHOE,CA 93=' PHONE(209)798-11356 <br /> AINLAY TANKTEGRITY TESTER TAFIELD TEST DATA <br /> 1 NAME ADDRESS PHONE <br /> TANKOPERATOR 2�_t:bm Svc. <br /> e6 0� <br /> 2 IDENTIFICATION ' CAPACITY-GALS. MANUFACTURER STEEL/FIBRGLS. AGE-YRS. <br /> TANKS TO <br /> BE TESTED <br /> 3 WATER DISTANCE FROM GRADE TO WATER INS: <br /> - <br /> TABLE <br /> 4 TANK WILL BE FILLED (TIME)ON <br /> TANK EXTRA 5 GALS PRODUCT AVAILABLE FROM .ti <br /> FILL-UP <br /> FILL UP TO BE ARRANGED BY 10R. PHONE( ) <br /> CONTACT AT STORAGE TERMINAD IS MR. PHONE( D <br /> 5 NAME ADDRESS PHONE <br /> OUTSIDE <br /> CONTRACTORS <br /> 6 NAME AUTHORITY PHONE <br /> OFFICIALS <br /> TO BE <br /> CONTACTED <br /> t 7 , <br /> 1 <br /> i <br /> SPECIAL <br /> NOTES OR <br /> r <br /> ` PRECAUTIONS <br /> 8 ALL TESTS WERE PERFORMED IN ACCORDANCE WITH PROCEDURES DESCRIBED IN SOILTEST S <br /> INSTRUCTION BOOK. CRITERIA FOR TIGHTNESS IS ESTABLISHED BY NATIONAL FIRE PROTECTION <br /> ASSOCIATION BULLETIN. N.F.P.A.329. <br /> TANK tS TANK IS LEAK RATE <br /> TEST TANK(DENT TIGHT NOT TIGHT G.P.H. TEST DATE <br /> RESULTS ID <br /> E <br /> 9 THIS CERTIFIES THAT THE TANKS DESCRIBED WERE TESTED BY THE UNDERSIGNED AND THAT THE STATED <br /> RESULTS REPRESENT THE TRUE STATE OF THE TANKS ON THIS DATE TO THE BEST OF MY KNOWLEDGE. <br /> ' CERTIFICATE NO. <br /> I� CERTIFICATION SIGNED ISSUE DATE <br /> lu <br /> 0 <br /> FOR(t'EST COMPAN)) --- <br /> ADDRESS <br /> m <br /> STATE ZIP <br />