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1 � _ <br /> r <br /> ' - Data Chart for Tank System Tightness Test <br /> _ pt#ro ode <br /> TANK TESTER ' 3 <br /> )• r <br /> 1 OWNER r <br /> property <br /> Tank a ,1 Name Adore-.5 Telephone LQ. <br />' } Nane Addra3� - f - <br /> 761sGh7na � <br /> 2 OPERATOR , vtz <br /> e. �wZ Pit l <br /> flame ACCress C. �L1r'iarLohone <br /> 3 REASON FOA TEST a YC fd- -eS 'f' 7 r <br /> t 4 WHO REQUESTED <br />' TEST AND WHEN Nama >v Tltia Company OF Atli J Da• ' <br /> ti Adtlreea Talaphona �.+ <br /> 5 WHO IS PAYING Cie WK et-,y-t- _ <br /> FOR THIS TESTI Company Agency or 1ncilvldual , = Peron Awthonzrng ,"Titre L To19Phone w <br /> ! 81111ng Aodreaa T City _ State <br /> t Attention of Order No Other Inatruerlons -{ <br />' r S TANK(S) INVOLVED ldentlty by Dlrectldn Capacity Grade Aporox Aga S eelF aerzla,5 ~ y <br /> Y ` ` <br /> 7 INSTALLATION Locateon Covor Fula yenta Stohona D,rnds <br /> DATA 10; 7L <br /> t <br /> r - - <br /> moan 102 46 driveway Cant tie bfatk Top S,ze Tlte'rb mike Orap S,--on Remele <br />' Rear of sidtron etc Eartn at tubes Remote Fins Size M3nit616ed whrCn r.10-7 Wake fi.sown <br /> 8 "UNDERGROUND ly he watercvv ^e rare, <br /> WATER Depth to water tabld It known <br /> ❑ Ye, '� NO <br /> 9 FILL-UP ` — <br />' ' Tan*3 to oa filled s W^ oata Arrangod by <br /> ARRANGEMENTS Nsme Tvv:;hono <br /> MpVr <br /> r <br /> 1 10 ° TECHNICIANS <br /> cr IC- •, <br /> # 11 OTHER <br /> #+ INFORMATION <br />' OR REMARKS <br /> Ad CI'end!tgfcrination on any iters noovo Off j;13 Jr e•her3 TC bA adv}reo wnen to9trng[*;n Progress oe eitmotetaa loiters a etsv,cfs prwent <br /> duritp toil 11- r <br /> 12 TEST RESULTS Tests were made on the above tank 5ysterns In aCcordsnee with 1951 procedures proatribad for pp�tp1!}p <br /> sL detatts on slt+C'ied test Chetta wl w■ — <br /> Tank itlentnccaGon TranWllhfn Toteranee Out of Tolerance Cote Te,c: <br /> 1 <br /> iwier-1,- C -2 <br /> This 16 to Certify that tha"lank systerns woes tented on th9 dales)shown Tho49lndScsied as TTaht moat iha enterls eetabliehed.y the Nstionsi Ara <br /> 13 CERTIFICATION <br /> Protactton Association pamphlet S:9 <br /> parson aarufylng <br /> C �V 1 1'C�� lK" J <br /> r <br /> 1 + J / ing,:YCnI �rtr}r C �`D'*• ny ``+ ��_y r{ / .�. <br /> � �/� / -3 �r.r" y�� �7G _7J I N �13� <br /> Coe isl No of Thermal San.,or CBn,realfon Num C6r / ACSrr.s <br /> RECE}VLD _ 14' 1 1 ;9,91; <br />