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Data Chart for Tank System Tightness Test. <br />pQIro Tree <br />PLEASE PRINT TANK TESTER .9 12—P <br />1. <br />OWNER Property r❑ <br />Tank{e) III <br />7-ZZefP6r4 —46 k'i1J <br />Name t AL a�� rnantratlw• <br />% C c� cu I 1 Tip' 4A.+' ll" u <br />�TNrphon• <br />Name <br />Address <br />R.Or.e.atativ. <br />Toloahone <br />2. <br />OPERATOR <br />Name Acidrest <br />Teiaohons <br />3. <br />REASON FOR-' <br />TEST <br />(Explain Fully) <br />4. <br />WHO REGUESTED <br />TEST AND WHEN <br />%9z <br />Name Title Company Of Affiliation <br />Oat* <br />Address <br />T.i.ohone <br />5. <br />WHO IS PAYING <br />FOR THIS TEST? <br />Sb U rj)-) 4n4 <br />Company, Agency ar Indlviduel Person Aulhorlxing Tills <br />Trloohane <br />Billlne Addles City state <br />210 <br />Attention of: Order No. other Instructions <br />B. <br />TANK(S) INVOLVED <br />Identify by Llirection <br />Capacity <br />Brand/Supplier <br />Grade <br />Approx. Age <br />Steel/Fiberglass <br />s Q ii d <br />s t <br />7. <br />INSTALLATION <br />. <br />Location <br />v <br />: a <br />►r r fy <br />No'tn�n*m'rdrlvsw*Y. <br />Rear of station, etc. <br />Cover <br />o f <br />0!iGK <br />Concrete, Black Top, <br />Earth, sic, <br />Fills <br />Sias, Tit.flll meke. Drop <br />tueee. Remote Fills <br />Vents <br />�AJ <br />Size, monllolded <br />Siphones <br />Which lanks! <br />Pumps <br />��DATA. <br />„,„ Ate"' <br />suction, Remote. - <br />Make it known <br />8, <br />UNOERGROUND <br />WATER <br />4.— I 0 �1 <br />Depth to the Water table ! _ <br />Is the -star over the tank 1 <br />❑ Yes f<No <br />Tanks to be titled �D OU hr. f r' �? [)ase Arranged by <br />9. FILL -UP Nome Telephone <br />ARRANGEMENTS Extra product to "top off" and run TSTT. How and who to provide? Consider NO Lead. <br />Terminal or other Contact ft 17J <br />For notice or inquiry G <br />Company Name Twlephcne <br />10. CONTRACTOR, <br />MECHANICS, <br />any other contractor <br />involved <br />OTHER <br />INFORMATION <br />OR REMARKS <br />Additional information on any items above. Officials or others to be advised when testing is in progress or completed. Visitors or observers present <br />during test etc. <br />Tests were made on the above tank systems In accordance with test procedures prescribed for pFirO TtfP <br />t 2. TEST RESULTS as detailed on attached test charts with results as follows: sT 3 <br />Tank Identification TightLeakage indicated Date Tested <br />ril <br />4' <br />This Is to Comity that these tank systems were tested on the dale(s) shown, Those Indicated as "Tight" meet the criteria established by <br />13. CERTIFICATION <br />the National Fire protection Asoelatlon Pamphlet 329. <br />Date �✓ pe 4r Lawrence Tank Testing <br />/ SQd 1 P-0. BOX 407 BY: Signature <br />Senai Na. of Thermal Technician, <br />Sensor - DownieviNe, California 95936 (916) 289-3109 <br />