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6. TANK(S) INVOLVED <br />7. INSTALLATION <br />DATA <br />8, UNDERGROUND <br />WATER <br />9. FILL -UP <br />ARRANGEMENTS <br />10. CONTRACTOR, <br />MECHANICS, <br />any other contractor <br />involved <br />11. OTHER <br />INFORMATION <br />OR REMARKS <br />12_ TEST RESULTS <br />Data dart for Tank System Ti e <br />Y gn ss Test <br />- `t TIte <br />TANK TESTER <br />-5 - -11 �. <br />r/_! C_ <br />----- _ <br />Representative Telephone �_� <br />AddresspresenlA[ive <br />Telephone <br />- <br />Name <br />Address <br />one <br />Name .._ _..__. <br />. - <br />title -.. _ <br />.. _ - -- - - <br />-. -- -- -- <br />CpmPtlnY or Aftilienon Ace <br />Dale <br />"1y <br />'.£ 'PRINT <br />1. <br />OWNER Property O <br />---- � ---- -._-------._ <br />Tank(s) <br />1 <br />Tide <br />2. <br />OPERATOR <br />3. <br />REASON FOR <br />TEST <br />(Explain Fully) <br />4. <br />WHO REQUESTED <br />Cover <br />TEST AND WHEN <br />5. <br />WHO IS RAYING <br />ps j <br />FOR THIS TEST? <br />6. TANK(S) INVOLVED <br />7. INSTALLATION <br />DATA <br />8, UNDERGROUND <br />WATER <br />9. FILL -UP <br />ARRANGEMENTS <br />10. CONTRACTOR, <br />MECHANICS, <br />any other contractor <br />involved <br />11. OTHER <br />INFORMATION <br />OR REMARKS <br />12_ TEST RESULTS <br />Data dart for Tank System Ti e <br />Y gn ss Test <br />- `t TIte <br />TANK TESTER <br />-5 - -11 �. <br />r/_! C_ <br />----- _ <br />Representative Telephone �_� <br />AddresspresenlA[ive <br />Telephone <br />- <br />Name <br />Address <br />one <br />Name .._ _..__. <br />. - <br />title -.. _ <br />.. _ - -- - - <br />-. -- -- -- <br />CpmPtlnY or Aftilienon Ace <br />Dale <br />/1�f/ �`(,/�•y� /J <br />Co pay or indivi�.Lc <br />Address <br />Telephontl <br />Pelson Authoiiaind�Z <br />---- � ---- -._-------._ <br />`-ill- <br />bing Address �-'-�_--� <br />City <br />Tide <br />_ <br />entif by Directi n Capacity <br />zz- <br />Order No. <br />Brand/ upplier <br />f��+ // "�// <br />State <br />Other Instructions-"-'--- -- - <br />rade '4Pprox. q a Sta erBfa s <br />tion <br />nQ� <br />Cover <br />Fills <br />A/ <br />Wants <br />Siphonas / <br />�� <br />ps j <br />NonM inside diivnway, <br />Reel of $ttltlon, etc. <br />Concrete, Bieck Top, <br />Eanh. etc. <br />Size, Titeflll make, Drop <br />RRemote Fills <br />Size, Manflolded <br />Which fenks? <br />Suction, Remote..s, <br />Make it known <br />Depth 10 the Water table _ <br />- <br />Is the water over the tank 7 <br />El Yas No <br />Tanks to be filled hr.._ <br />Date Arranged by <br />`Extra product to "top oft" and run TSTT. How <br />and who to provide 7 <br />Consider NO Lead. Name - 'Tgiaphone ' <br />Terminal or other contact <br />for notice or inquiry -- <br />Company <br />me . __. _. --_- Telephone <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 />Tesla were 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 />nk demrfication Ti9 _ Leakago Indicated Ar Date Teste <br />13 FI <br />This is to centat the nk systema war sled on the <br />the r Asociatio et 329. <br />te <br />as "Tight" meet the criteria established by <br />I / f <br />eifLifs#i e t—T.._..- <br />_ r{-�� p q�tra Si rsature '---� <br />- - E r-Slr <br />Senal No. o Thermal �� '� ` -' - "�- <br />Tach I ans .-.__- - <br />Sensor <br />7hl iV�i , t r'';'1, �Z�i VI7(rI�r4 95823 -_ <br />