Laserfiche WebLink
'Data Chart for Tank System <br />Pe't�ro Tete <br />PLEASE PRINT7 TANK TESTER <br />40 <br />Tightness Test <br />1. <br />OWNER Property — <br />7 -If S_jr rpt' ', 272-) r'C C. 1, C- LL <br />Tankis) <br />Name Addresh Reple7engbve <br />Telephone <br />Name Address Reoresentahve <br />Teleonone <br />2. <br />OPERATOR <br />Name Atltlrna <br />Teiepnone <br />3. <br />REASON FOR <br />TEST <br />JF r!(, L t t i n) <br />(Explain Fully) <br />- - <br />4, <br />WHO REQUESTED <br />r)L-E L r <br />TEST AND WHEN <br />Name Tine Company or Affiliation <br />Date <br />Address <br />Taleohone <br />5. <br />WHO IS PAYING <br />S C L T t -f C �NO C (_ C :7 <br />FOR THIS TEST? <br />n <br />C poy. Agency or nOvidual Person Xuthdrrzlnp, Tina <br />°�' � � <br />Telephone <br />eine Atldrna - c4y State <br />Zip <br />Attention of 04def No, Other Instructions <br />6. <br />TANK(S) INVOLVED <br />Identify by Direction <br />tl:5r Cit <br />Capacity <br />002 <br />Stand/Supplier <br />Grade <br />g v — O' <br />Approx. Age <br />Steell Fiberglass <br />/zlocf <br />CC <br />I U I I- <br />�S <br />7. <br />INSTALLATION <br />DATA <br />Location <br />Fr CN c, <br />North inside driveway. <br />Rear of station, etc. <br />Cover <br />C utt flit'-r'k <br />Concrne, Black Top. <br />Earth. etc. <br />Fills <br />{ t( <br />Size, Tirenu make, Droo <br />tubes. Remote Fifls <br />Vents <br />�! <br />Size. Mantroided <br />Siphons <br />Which tanks <br />Pumps <br />Suction, Remote. <br />".take J known <br />8. <br />UNDERGROUND <br />WATER <br />Is the water over the tank 7 <br />Depth to the Water table Yea No <br />9. <br />FILL -UP <br />ARRANGEMENTS <br />Tanks to be filled (�" hr, 5' Date Date Arranged by <br />Name <br />Extra product to "top off' and run TSTT. How and who to provide i Consider NO Lead. <br />Telepnone <br />Tarminai or other contact <br />for notice or inquiry <br />COmoeny Name <br />Tv4pnone <br />10. <br />CONTRACTOR. <br />MECHANICS. <br />any other contractor <br />Involved <br />11. <br />OTHER <br />INFORMATION <br />OR REMARKS <br />Additionoi information on any stems above. Olficaais or others to be advised when testing is In progress or completed. Visitors or observers present <br />during test etc. <br />12. <br />TEST RESULTS <br />Tests wen made on the above tank systems in accordance with test procedures prescribed for <br />as detailed on attached test charts with results as follows: <br />Tank Identification Tight Leakage Indicated Date Tested <br />•lam% ^`f)s 14 <br />=`i'- C <br />C J4 OZ - c A- <br />-2- -'s <br />13. CERTIFICATION <br />Date <br />Serial No. of Thermal <br />Sensor <br />This is to certify that these tank systems ware tested on the dates) shown. Those indicated as "Tight" meet the criteria established by <br />the National Fire Protection Asoclatlon Pamphlet 329. <br />F 1�. Lawrence Tank Testing <br />R0. Box 407 Ipnature <br />Technicians ©ownieville, California 95936 (916) 289-3109 <br />