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KN <br />TECHNOLOGY FOR TANKS <br />AND THEIR ENVIRONMENT <br />Service #rlder Agreement <br />VacuTect Tm Leak Detection <br />Reg: 990, 9919 9929 9939 9949 9959 996. <br />Circle One <br />Fust. PO# TEST DATEC:;%,,,,,, T Z Acc't. Cust. # <br />Tank <br />Owner <br />Owner <br />Address <br />Owner <br />Name <br />Owner <br />Phone <br />FAX No. <br />EXACT LOCATION <br />Invoice ltior-iM <br />Invoice <br />Address 2, Ep,,X, 14t12, <br />Lc •_T 1A 4-,Z6.11 <br />Invoice <br />Contact <br />Invoice <br />Phone (20gN- <br />FAX No <br />Facility 4114 1 SCHEDULED START DATE 1*6n rrr. 2"q, 1993 <br />Start Time: el W3n -- End Time: 12co <br />Applicable Specifications: <br />Unit # 4 Z Testers Cert. # 1:10 Agent SO# 083519 <br />Taxable: Message: <br />PARTS <br />TANKS TESTED <br />LINES & LEAK DETECTORS . ,. <br />Pass/Fail �, <br />Pass/Fail <br />Tank <br />1: Size <br />_ Product Q4)@,i_BhIS1151-- <br />Line <br />1 Leak Det Test <br />Tank <br />2: Size <br />jl214-- Product Pj)bl_ Par -5._ <br />Line <br />2; . CASs Leak Det Test <br />Tank <br />3: Size <br />12 % Product Sil A <br />Line <br />3 _ Leak Det Test <br />Tank <br />4: Size <br />Product <br />s <br />�z+Line <br />4 Leak Det Test � n <br />Tank <br />5: Size <br />Product <br />Line <br />5 Leak Det Test , <br />Tank <br />6: Size <br />Product <br />Line <br />6 ' Leak Det Test <br />Tank <br />7: Size <br />Product <br />Line <br />7 Leak Det Test <br />Tank <br />8: Size <br />Product <br />Line <br />8 Leak Det Test <br />Tank <br />9: Size <br />Product <br />Line <br />9 Leak Det Test <br />Tank <br />10: Size <br />Product <br />Line <br />10 Leak Det Test <br />Site Survey: <br />$ <br />Helium Leak Detection Service: Start Time — <br />End Time- <br />ime <br />PARTS INSTALLED: Quantity Model <br />Other Parts <br />Installation Labor. <br />Red Jacket Leak Detectors <br />TANKNOLOGY is authorized to make and will be paid at its commercial rate for making any minor adjustments and <br />repairs to piping and valves necessary. See Standard Terms and Conditions on the reverse side, which are incorpo- <br />rated herein by reference and which are included as part of this agreement. By signing this agreement, you ac- <br />know�bdge you have read, understand and agree to the terms and conditions on the reverse side of this agreement. <br />ACCE ED BY: TANKNOLOGY SERVICE DIVISION <br />Name: (� �.� Name: # ..a.,._ I+A 0 r qA - <br />Title:Title: <br />For: ('4J !� Signatu <br />Customer <br />Signature: Date: QJ- npq s Z5; 1233 <br />Date: Time: 2 State: eot License <br />Printed in the U.S.A. <br />TANKNOLOGY CORPORATION INTERNATIONAL <br />5225 Hollister Street • Houston, Texas 77040.6294 • 800-888-8563 • Fax: (713) 690-2255 <br />TAK-03 <br />