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*openYFl <br />OPERATOR <br />Identity by Direction CapacitY <br />6.TANK(S)INVOLVED <br />t INSTALLATION <br />DATA <br />.~,. <br />UNDERGROUND <br />WATER <br />t <br />ale, Black TOP, <br />North Inside dlivew$VCon"', <br />Size, Titofill Make, D(OP <br />tubes, Remote Fills <br />Real of station, at;. E.111I. etc. <br />Nome <br />resentSt vs <br />Til Phoitill <br />less <br />Address <br />Name <br />-�u��r <br />-------�-----�---�--� <br />� <br />— --�--�---�--� <br />Title <br />°°"~°tiO^ <br />Name <br />PIC, 15644- <br />elophonS <br />- <br />icity <br />_C�id�r N C <br />' <br />Steel/ Fiberglass <br />- A —Ain- <br />Approx. Age <br />Identity by Direction CapacitY <br />6.TANK(S)INVOLVED <br />t INSTALLATION <br />DATA <br />.~,. <br />UNDERGROUND <br />WATER <br />' <br />Depth to the Water table <br />-----� om° Affa^«�»' <br />– <br />`"�"�~~'~-----' <br />mprovide r <br />Consider w~oLe"o <br />9. FILL -UP s*mpmw"�m'mnmr�d"°rsn. How �dwho <br />nnn°mn""^~'. ' ------- <br />Terminal <br />*"m° <br />"wm� -----------w°"" <br />for notice or inquiry--------- <br />10. <br />nwuiry------- <br />SiphoneS Pumps <br />Vents ho ; L <br />suction. Remote, <br />'Which tanks 7 Make If known <br />ESIzeManifollded <br />Is the water over h. lank ? <br />0mm 9 No <br />12. TEST RESULTS <br />Telephone <br />IAF <br />SFU V��Jp,& is or observers Proton <br />during test etc. edures prescribed toy FloatrOT& <br />Ad - <br />at <br />fo <br />d rin <br />9 test <br />T T at to Made on the above tank systems In acCOndsPICO',vith test proc <br />ests we as detailed on attached test charts with results as follows. DateTested., <br />V6 5 <br />13. CERTIFICATION <br />� <br />Date <br />Serial NO of Thermal <br />Sensor <br />led as "Tight" mitat the criteria established b <br />clate(s) n. Those c <br />This to to codify that these tank systems were tested on the <br />the National Fire Protection AsMistiOn Pamphlet 329. <br />Ompa L <br />Ajdress <br />t <br />ale, Black TOP, <br />North Inside dlivew$VCon"', <br />Size, Titofill Make, D(OP <br />tubes, Remote Fills <br />Real of station, at;. E.111I. etc. <br />' <br />Depth to the Water table <br />-----� om° Affa^«�»' <br />– <br />`"�"�~~'~-----' <br />mprovide r <br />Consider w~oLe"o <br />9. FILL -UP s*mpmw"�m'mnmr�d"°rsn. How �dwho <br />nnn°mn""^~'. ' ------- <br />Terminal <br />*"m° <br />"wm� -----------w°"" <br />for notice or inquiry--------- <br />10. <br />nwuiry------- <br />SiphoneS Pumps <br />Vents ho ; L <br />suction. Remote, <br />'Which tanks 7 Make If known <br />ESIzeManifollded <br />Is the water over h. lank ? <br />0mm 9 No <br />12. TEST RESULTS <br />Telephone <br />IAF <br />SFU V��Jp,& is or observers Proton <br />during test etc. edures prescribed toy FloatrOT& <br />Ad - <br />at <br />fo <br />d rin <br />9 test <br />T T at to Made on the above tank systems In acCOndsPICO',vith test proc <br />ests we as detailed on attached test charts with results as follows. DateTested., <br />V6 5 <br />13. CERTIFICATION <br />� <br />Date <br />Serial NO of Thermal <br />Sensor <br />led as "Tight" mitat the criteria established b <br />clate(s) n. Those c <br />This to to codify that these tank systems were tested on the <br />the National Fire Protection AsMistiOn Pamphlet 329. <br />Ompa L <br />Ajdress <br />