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DATA CHART <br />For Use With <br />prtro71j�y'`++`� <br />.00ATION: I f` i `,j ! / r q" _ " tom/ �/� is f%y�. r% 6•^. •�C. "C i'V ' 6�.�"' <br />Slrsel No. en0/a Coma1 City Slala� T plrone No. <br />,WNER: _9,,QCa /l /.,7 /../l!- :ST <br />3PERATOR: _ <br />MIMES <br />111=d 4 <br />N•In <br />REASON FOR TEST_ �w K Cs <br />p00101. MY1, el Olner //��(�//�AYUN41 111011141001 1Mn 16-10n) <br />�C� l ^� <br />Teleah— No. <br />Z o <br />�t4e <br />6 TEST REQUESTED BY: <br />f <br />�■ <br />N <br />V <br />y1 V <br />Nom/ /` w �//'`'' <br />POfObn OlYel NO. <br />B1Y1ne AY01444 <br />6 SPECIAL INSTRUCTIONS: <br />7 CONTRACTOR OR COMPANY MAKING TEST <br />/,//►'� <br />SCQ <br />///'}; p <br />rf <br />/' "//}/!_t®a-p�/,/� <br />Je�/A! <br />♦ },� <br />�` 'f ga`A!y <br />MECHANIC(S) NAME <br />❑ <br />`e•""f~'j <br />.V ./ <br />OF <br />0 IS A TANK TEST TO BE YES <br />MADE WITH THIS LINE TEST? <br />11 NO <br />8 MAKE AND TYPE OF <br />PUMP OR DISPENSERS <br />a r <br />e p <br />Rai <br />COVER <br />APPROXIMATE <br />a <br />10 WEATHER .. TEMPERATURE IN TANKS __ -F _ -C OVER LINES <br />BURIAL DEPTH <br />Com"Is. Bleck Too. etc. <br />71 IDENTIFY <br />EACH LINE I <br />12 TIME <br />13 LOG OF TEST PROC <br />AMBIENT TEMPERATURE,EDURES. <br />id PRESSURE <br />16 VOLUME <br />16 TEST RESULTS <br />psi OR kPa <br />READING <br />NET <br />_w�% <br />AS TESTED <br />(MILITARY) <br />WEATHER. EPC. <br />BEFORE AFTER <br />CHANGE <br />CONCLUSIONS. REPAIRS AND COMMENTS <br />BEFORE I <br />AFTER <br />IDPD � <br />..� ,•��,���, <br />ys <br />Mrd <br />���c��" �t, .� <br />402 <br />!r <br />. o3�s <br />0 <br />5 <br />'G�Z 5s <br />J4Y3 <br />�� <br />1 i'C I <br />43 <br />MIMES <br />111=d 4 <br />■ <br />f <br />�■ <br />/. =r/ <br />e'er` W- <br />■ <br />�.�� <br />_w�% <br />