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Data Chart for Tank System Tightness Test � IE 6u <br />CIUMION's PRMISTON TAM TNSTM <br />PLEASE PRINT <br />Capacity <br />Br®ndlSuPOief <br />Grede <br />Apprae. Age <br />Steel/ iberpl® <br />1. <br />y-�a <br />OWNER Property �(J <br />�1••` <br />let IM <br />`G° Armor �- <br />�/ 1L <br />�. <br />6• G% - <br />dc'�%im:� ' ` .' f� ` <br />ARRANGEMENTS <br />Took(s)a! <br />Ij�LI <br />NAVA <br />Cover <br />��� <br />Concrete. ®leek Top. <br />981111. ate. <br />flus <br />ey <br />T <br />bras. TNefin make. Oros <br />tubas. Ramate fins <br />Aearaee <br />_ <br />Reo/Menlative Telephone <br />Pumps <br />�t •M" d7d74Fes►lr44 <br />l% Jrf eelf <br />suotiee. me -via. <br />Make it known <br />10. <br />rseme <br />— -- — <br />- — <br />----. <br />Addis$. <br />-- -- <br />RsPlelenrlllxe—�el•Phewe __ <br />Z. <br />OPERATOR <br />BName <br />involved... <br />•.,.. ...�.__.._—. r .._. ...—e. _._.. .... <br />11- <br />OTHER <br />......—.... _... -- _-- ---- <br />INFORMATION <br />Address <br />Telaaheee <br />3. <br />REASON FOR <br />'I N GOVERNING <br />QUND STORAGE <br />OF HA2ir SIS• STANCES <br />TEST <br />SUBCHAPTER <br />16 OF <br />CHAPTER <br />3 OP TITL1; 23 <br />OF THE CALIFORNIA ADMINISTRATIVE CODE <br />I! detailed GA 4111aohe4 teat Charts with results as follows. + <br />(Ehdein Fully! <br />Tank Identtflcabon Ttght 1,481,$04 IA414e144 I Oat* Tested <br />13. <br />CERTIFICATION <br />The 1s to cettlly that these tank systems wero tested on the details) shown, Those Indlosted as "nAht" most the orttarts established by <br />2 3r -- <br />the sationo ire Protection Asoclatlon f ilrphlet',29. <br />ION'S PRECISION TANK TESTING <br />4. <br />WHO REQUESTED <br />r1Z <br />"None <br />—_. <br />a t� <br />_.. <br />TEST AND WHEN <br />Name <br />.� ... <br />Tlna <br />cola iiellen4�olt1 Oeii"-'-- <br />.3 aI lma,��1 <br />.. <br />Addis%& <br />5, <br />WHO IS PAYING <br />OWNFR <br />comne sae <br />Aaev <br />' <br />puthotieus <br />L-1 <br />"xa „ <br />- .-PET v: i f �9sie-r-I' <br />FOR THIS TEST? <br />pany, o1 viduar <br />Peraen <br />TaleorleAe <br />ahhna Annrsca <br />---•—� f.1w <br />sash ,Tin` <br />Assam i al <br />Maw Is.. <br />_ ... - Odrl Inal",eel"nf ... ... ...-- — - <br />Identify by Oifection <br />12 <br />6. TANKS) INVOLVED _!60de 112— <br />Capacity <br />Br®ndlSuPOief <br />Grede <br />Apprae. Age <br />Steel/ iberpl® <br />Tank$ to be filled hr 2X `ltd Data Arranged by — <br />9. <br />Fill -UP <br />N.m. TalaPhonr <br />ARRANGEMENTS <br />Extra product to "top off' and run TSTT. clow and who to provide? Consider NO Lead. <br />Location <br />Location <br />i. INSTALLATION$ d'K <br />DATA <br />0dj <br />Nelth inside driveway, <br />Rest of station, ate. <br />Cover <br />��� <br />Concrete. ®leek Top. <br />981111. ate. <br />flus <br />ey <br />T <br />bras. TNefin make. Oros <br />tubas. Ramate fins <br />Vomit <br />- <br />site. Mannotded <br />siphons <br />whiah tense T <br />Pumps <br />�t •M" d7d74Fes►lr44 <br />l% Jrf eelf <br />suotiee. me -via. <br />Make it known <br />a. <br />unut"Uhuurou <br />is the water aver the tank i' <br />WATER <br />Qepih to the Water table Q To: No <br />Tank$ to be filled hr 2X `ltd Data Arranged by — <br />9. <br />Fill -UP <br />N.m. TalaPhonr <br />ARRANGEMENTS <br />Extra product to "top off' and run TSTT. clow and who to provide? Consider NO Lead. <br />Terminal or other contact N O T APPLICABLE <br />Por notice of ineuiry_...__..- <br />CeMa►ny Nadu THeanaeA <br />10. <br />CONTRACTOR, <br />— -- — <br />MECHANICS, <br />NUT APPLIUABtS <br />any ether aenlreeter <br />involved... <br />•.,.. ...�.__.._—. r .._. ...—e. _._.. .... <br />11- <br />OTHER <br />......—.... _... -- _-- ---- <br />INFORMATION <br />OR REMARKS <br />_ _ <br />Additional information on any -Illms above. ic-Als of others to be advised when testing 1s In progress or eampkted. Vrallais at Observers Present <br />during last eta. <br />Tests weirs made on the above tank systems In aceordanae with t+st pr000duros presarimd for [1 <br />17. <br />TEST RESULTS <br />I! detailed GA 4111aohe4 teat Charts with results as follows. + <br />Tank Identtflcabon Ttght 1,481,$04 IA414e144 I Oat* Tested <br />13. <br />CERTIFICATION <br />The 1s to cettlly that these tank systems wero tested on the details) shown, Those Indlosted as "nAht" most the orttarts established by <br />2 3r -- <br />the sationo ire Protection Asoclatlon f ilrphlet',29. <br />ION'S PRECISION TANK TESTING <br />LI, <br />Coto <br />an 1K eA y: <br />1431 eeY <br />622 <br />_� .. <br />a t� <br />r <br />