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Data Chart for Tank System Tightness Test <br />a PLEASE PRINT <br />2 <br />G <br />a <br />r� <br />❑❑❑❑❑f <br />1. OWNER —p" ❑ <br />T.MbI ❑ <br />2. OPERATOR <br />Rum <br />Aaa�sif LP Repr.nnwVw TN.pnww <br />N•im <br />barns ZIP R•pwsanba.• ii•Pnone <br />Aaaw.e I ZIP Ta'0"0n° <br />3. REASON FOR <br />TEST <br />(E.PWn RaM <br />I <br />4. WHO REQUESTED <br />TEST AND WHEN <br />I <br />Rim <br />n,,, c�«Allow.. lUt• <br />Aaam• ZIP Tgepmn. <br />S. TANK INVOLVED <br />u,. um. <br />ro. m•nnaa.a b� <br />benne by TN�Mbn CeD.oaY <br />eaa/SuPP.0 macre APPnw. Am S1esURmepime <br />I <br />6. INSTALLATION <br />DATA <br />Vaw Sip— PumDz <br />`� '•, <br />row. mA.. 0w SuCwRumw. <br />\None baw aweu.T. ..--¢ftk Toa •. wl <br />Rw als�mbn. q¢ �, E.I111• elC. �-- w•n. R.mow Nb Sze. Wabba uao 0 wMeT Ntli. P k- <br />7. UNDERGROUND <br />WATER <br />owoo 000 .wwa• swa. <br />— Raw+««awRwWT <br />❑Ta ❑NP <br />B. FILL -UP <br />ARRANGEMENTS <br />T•m.bm(owa v. `Do". ._ o+--_..., Rem. m.Pmn• <br />a°,"a'T ROwa <br />bma.awwwT �_. Rum TtlzMam <br />9. CONTRACTOR, <br />MECHANICS. <br />•nT ana eonurta <br />k1•ob.a <br />/ <br />10. OTHER <br />INFORMATION <br />OR REMARKS <br />' <br />bakawwbmwPaaaieT Nwm <br />gpaaaanu.bmaaWaumnlawpbb TW�•a ammpWa6WRm.aareM•w Tn.a crams wA ab. <br />11. TEST METHOD <br />❑ PETRO TITE <br />❑ PETRO COMP <br />❑ QUICK CHECK 2000 <br />11a. TEST RESULTS <br />Tab was mals al a. ah. <br />adot,96dal <br />TW benaRWbn <br />Ink SM— M —.'* w wM blot Wsadua WaaIE.A bT <br />albahsA look aubwkn 1—db a fcisws: <br />To" Na \Mens a+e�9e Pw Ror Ww Teelaa <br />12. SENSOR <br />CERTIFICATION <br />ou• <br />$uW Nw a 9Rwmw <br />13. CONTRA91IR CERTIFICATION ; <br />4enPJasns <br />r, <br />... TMYq conpaobr •r can9uiY• or 84mse• <br />(:waRoellbl <br />2 _. <br />