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Data Chart for Tank System Tightness Test <br /> PLEASE PRINT <br /> 1. OWNER_F!?opa9'_ _ ^ /T/ d 5/UCJCnJnJ /yl S L N'L[ R/ 9 10� 7-44VIeY 2,4 r-d-5 V-Z L //DD <br /> �( Neme Address zip R.,...rw.h. Telephone <br /> Tm41s7�1 <br /> Nems Address Zip Represents('. Tel.pnww <br /> 2. OPERATOR '6FN iv6 C49 a, I//&D N r T <br /> Name Address zip .I.phorM <br /> 3. REASON FOR <br /> TEST <br /> (Explain Fully( <br /> 4. WHO REQUESTED Sd1? v c4rrs lass Isr rvL r /n .,F <br /> TEST AND WHEN N•'"1° Tam comps^,or Aaniatlun oats <br /> Add. Zip T.lepnone <br /> Identity NY Direction Capellly enw5uppibr finds Approx.After Steel/FII»rpleu <br /> 5. TANK INVOLVED 4evK dFl- <br /> Use wdltlonel lines - — <br /> formanifolded tanks <br /> Location Cover Fit* Vents &Phorias Pumpa <br /> 6. INSTALLATION W esT or- <br /> DATA <br /> FDATA 4 Copicoeror .2 .2 /' /1/UNC Sae? o^) <br /> G NNDMI inYdeuft4s`Y.' Concrete,Black Topase,Tnelill make.Drop Sudan.Remote. <br /> Rear of sualon.Mc EWh,atc. lubes.Remote Fills Site,Menilolded Whirl,tanks' Make i1 known <br /> 7. UNDERGROUND la the w.mr wer Ina tank' <br /> WATER D.OaINtM webrteaN from pods El Y. Elan <br /> B. FILL-UP <br /> Ton"toeefew/boo hr. [a'q'90 oat. Amanedby� f. .. .4_gsE%✓l31 /lGE�f tri1-/106 <br /> Nem, Telephone <br /> ARRANGEMENTS Ex ra p oduc N lop o .rad un ank tea ar Now ew w7 provide? Consider NO Lew. <br /> m uC W u <br /> Terminal.rother <br /> tui7 1)7-Y 0 C7I%_erner/ Tt�Z2k .laT1r; �/ -//ab <br /> for Mtiae Or Irlaulry <br /> company Neme Telephone <br /> 9. CONTRACTOR, <br /> MECHANICS, <br /> any other contractor <br /> Involved <br /> 10. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> A&PIR,r of Inlo m stion on shy Renu shoes.Officials or Mhen tow adviwd when Noun Is in Woprw or completed.Visitors or abssrvers present during test,etc. <br /> 11. TEST METHOD ® PETRO TITE ❑ PETRO COMP ❑ QUICK CHECK 2000 <br /> 11 a. TEST RESULTS Tests were made on the above tank systems M accordance with test procedures prescribed for <br /> as detailed on attached teat charts with results as loltows: <br /> Tank Idestlllostion Tighe Leakage Indicated Det.Tested <br /> / 3ca/ CS —S' O <br /> 12. SENSOR 13. CONTRACTOR CERTIFICATION <br /> CERTIFICATION <br /> a y0 TeMna4M <br /> Det. C.W. I�ASE��iS4i1CC/L �lT'� O/� S caro,J C k f, f=/J <br /> AL <br /> / p� Q Twtkp Coneecbr a ComWnY BY: slpntlur. <br /> Soviet Ne.of ThermH CWincstiona /�r+/���� /t/G Y� S G�sJ('.tX I�/ STGr,E�rW�/ r'.ea <br /> Senwr <br /> q/-/0/y Awrwe <br /> certification 0 MM27 <br />