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t' •� i i ' :11 � '1� <br />'iTESTDATE.il <br />.y�i loll. .�r ... <br />OPERATOR <br />la, el StIttion# <br />mull A <br />�y1�K► <br />�.CATION <br />■ <br />LNNE(s) ONLY ANK(s)-LNME(s <br />LMs)-LEAK DET. <br />TANK(s)-lX4F-(s)-LEAK DET. <br />MAKE & TYPE OF PUMP <br />OR DISPENSER L7 �o /^ <br />COVER OVER <br />LINES <br />APPROX BURIAL P d <br />DEPTH <br />WEATHER <br />un <br />TYPES: <br />XLD P/N 116036-5 <br />PLD P/N 116030-5 <br />XLP P/N 116035-5 <br />DLD P/N116017-5 <br />BFLD P/N 116012-5 <br />I l Notes <br />CONTRACTOR. <br />CERTIFICATION <br />TECHNIC NUWMO <br />SIGNATURE <br />PETROItI' CERT. # 090993AO163 <br />OrT LIC N 91-1143 <br />Tinea Nana <br />Tree Signature <br />FEATURING-PETR -TITS <br />.._ . TRIM. 11WRTWU <br />CI I SHOW STREETS, BLDdS, TANKS, ISLANDS; PIPING (IF KNOWN), PUMPS OR DISPENSERS <br />FTA LEAK DETECTOR TEST INFORMATION Calibrate <br />10 PSI <br />LD Serlal Oppe�nien Test undeona elating Yes / <br />,... Number Resiliency TunLeak Rate Element PSI No <br />LINE TEST RESULTS <br />TESTS t3EREMADE ON 7HEMNE SYSMdSAS NOTED INACCORDANCE WITH TEST <br />PROCEDURES PRESCRIBED FOR AS DETAILED ON THE TEST CHART ON SIDE 2 <br />OF77IIS FORM IfTTFII RESULTSASPOLL WS: <br />LINE IDENTIFICATION NET VOLUME C%iANGE PER HOUR <br />PASS FAIL / INCONCLUSIVE Q <br />PASS ,/ FAIL / INCONCLUSIVE 11 <br />V n PAS / FAIL / INCONCLUSIVE ,/ 5.) I- t t-® <br />PASS., /..,FAIL / INCONCLUSIVE <br />