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AFFORD.72097�44-0116 <br />416 2' Street Ga32 <br />AR <br />249 744-0112 Fax1 <br />ST TANK TEST <br />Site: a ;ter <br />'Wrest Date: <br />Address <br />city:.0-2s <br />Equipment: <br />'F <br />Test Method Developed By: <br />......y,wt <br />Tank Manufacturer . Industry Standard Professional Engineer <br />Other (Spec)_ <br />Test Method Uses: <br />Pressure �' <br />Vacuum Hydrostatic <br />+• Other (Specify): <br />Measuring Equipment Used for Testing: <br />i <br />d°` � r � �' <br />fin <br />«.�� i `�► <br />Tank # <br />Tank# <br />Tank # <br />Tank Capacity:an< <br />k b <br />Tank Material: <br />Product Stored: <br />Off <br />Wait time between applying <br />Pressure/vacuum/ water and starting <br />test: <br />Test Start Time: <br />Initial Readin (Ri): <br />01" <br />Test End Time:`x <br />Final Readin (R <br />" <br />Test Duration: <br />�w <br />Chan e in Readin (Rf-Ri):� <br />Pass/Fail Threshold:" <br />Test Result:LO <br />e <br />Was sensor removed for testing? <br />. <br />Was sensor properly replaced atter <br />e <br />testing? <br />Comments — (include information on repairs made to testing) <br />Technician: Lyle D.* Nimmo ICC #5249115 -UT Exp. 07/01/09 <br />Signatures Date:,`a <br />