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10. CONTRACTOR. <br />MECHANICS, <br />any other contractor <br />involved <br />11. OTHER <br />INFORMATION <br />OR REMARKS <br />n , y14- <br />^oonoonat information on any items above. Olfi <br />ciafs or others to be advised when testing is in progress or com tared. Visitors or observers <br />during lest etc. P present <br />Toots were made on the above tank systems in accordance with test procedures proscribed for <br />12. TEST RESULTS 28 detailed on attached test charts with results as follows: =rATA—e <br />Tank Identification <br />Tight Leakage Indicated Date Tested <br />r) <br />77 <br />I This 1:1110 codify that these tank systems were tested on the dates) shown. Those Indicated as "Tight** . <br />13. CERTIFICATION "We N ional Fire Protection Asoclation Pamphlet 329. Moral "for Criteds established by <br />oat. <br />It Tesbwe Connector or Company. ay. Srenatuw <br />• <br />—Al No of The—fil <br />Uata Chart for lank System lightness lest <br />__ <br />PtrPLEASE <br />PRINT <br />TANK TESTEPTite <br />1. OWNER Property (� <br />Tank(s) 121 <br />P7 <br />2. OPERATOR <br />Address lifforesontatfiro <br />k Slap ikk/_1 <br />Telephone <br />Name <br />3. REASON FOR <br />ddress <br />TelepAOM <br />TEST <br />(Explain Fully) <br />4. WHO REQUESTED <br />10 F SAe Ab� <br />TEST AND WHEN <br />fine <br />ualmoomy of Affillation <br />Date <br />5. WHO IS PAYING <br />Address <br />94 tA,/ (!4,4 <br />Tore-pho., <br />-s' <br />FOR THIS TEST? <br />OV Title <br />hollAft? 5/r <br />7- e <br />ti -w -d - <br />City Star* <br />rAnonvion <br />zip <br />fe at: Order No. Other Instructions <br />6. TANK(S) INVOLVED <br />Identify by Direction Capacity Brand/Supplier Grade Approx. Ago <br />Steel/Fiberglass <br />7. INSTALLATION <br />Location Cover Fills Vents Siphones <br />Pumps <br />DATA <br />North Inside driveway. Concrete. Bieck Top. Site. Titofill make. Drop <br />station.Rear of etc. Eon etc. tubes. Remote Fills Sits. MAInilottlod <br />Suction. Romotor. <br />8. UNDERGROUND <br />Which tanks? <br />Make it known. <br />WATERDepth <br />to the Water table Is the water over the tank <br />1:1 yes <br />No <br />9. FILL -UP <br />Tanks to be filled - hr. _ Date Arranged by <br />ARRANGEMENTS <br />Name <br />Extra product to "top off- and run TSTT. Now and who to provide? Consider NO Lead. <br />Telephone <br />Terminal or other contact <br />lot notice or inquiry <br />I - company Name <br />Telephone <br />10. CONTRACTOR. <br />MECHANICS, <br />any other contractor <br />involved <br />11. OTHER <br />INFORMATION <br />OR REMARKS <br />n , y14- <br />^oonoonat information on any items above. Olfi <br />ciafs or others to be advised when testing is in progress or com tared. Visitors or observers <br />during lest etc. P present <br />Toots were made on the above tank systems in accordance with test procedures proscribed for <br />12. TEST RESULTS 28 detailed on attached test charts with results as follows: =rATA—e <br />Tank Identification <br />Tight Leakage Indicated Date Tested <br />r) <br />77 <br />I This 1:1110 codify that these tank systems were tested on the dates) shown. Those Indicated as "Tight** . <br />13. CERTIFICATION "We N ional Fire Protection Asoclation Pamphlet 329. Moral "for Criteds established by <br />oat. <br />It Tesbwe Connector or Company. ay. Srenatuw <br />• <br />—Al No of The—fil <br />