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Data Chart for Tank Sysiem Tightness Test <br /> PLEASE PRINT <br /> 1. OWNER Priew 1 JMoOoit . L+ <br /> Tankul Name Address Ropreaenbtive TalepnpN <br /> -sew-A& <br /> Narpa Aedrw Reprxepbtlw TN.prone <br /> 2. OPERATOR wme TNepnon. <br /> 3. REASON FOR <br /> TESTyf <br /> (Explain Fully) <br /> 4. WHO REOUESTED <br /> TEST AND WHEN Naw rtes Company orAtalipun Dat. <br /> �l o.Tr �Sa�t,Zv <br /> Aedrw TNepebne <br /> Identify by Dlractpn Lapady Brand/Supplier Grade Approx.Ape Swe/Fllbrglw <br /> 5. TANK INVOLVED pop AQP <br /> ,ovolem <br /> tax additional unw, <br /> for manttaldad Wks Va1< G <br /> Location Dow Fill. Verb slow se Pump. <br /> 6. INSTALLATION SE Few colveA40iCQ <br /> DATA a// NV 8�l�iF <br /> T �S� o <br /> Nonn inside miens". Concrete.Slam Top, Slate,mtatlll MO,Drop Suction.Fashion, <br /> Fw of rol a e.etc Earth,an. tubes,Remote Mile Sze,Mandolded Which tanks? MO.It known <br /> 7. UNDERGROUND to ins andretvsr the tank? <br /> WATER Depth to the water bole ❑we ❑No <br /> 8. FILL-UP Tanks to be filled hr. Dab Arranged or <br /> New Telephone <br /> ARRANGEMENTS Extra product to'Tdp oral dna run tank let«. Now end who no proMds? DonaiMr No teed. <br /> T.Ms1 or omat conned <br /> for notice or irpuir, <br /> Company Nem. Telephone <br /> 9. CONTRACTOR, <br /> MECHANICS. 2500,olkl <br /> any other Mintradw <br /> Involved <br /> 10. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> Additional IntormNion on any Ibm.alcove.Officials or others In ce advised when tatting Is In progrex or computed.Makd,or obwrwrs preakee during NO.p <br /> Testa were made Ian the above tank systema In accordance with teat procedures prescribed for <br /> 11. TEST RESULTS as detailed on attached teat charts with result,as follows: <br /> Tank ltlmdiiwlisn�a�/ Tight Leakage Indicated zDab Teets <br /> CPO <br /> % I yes - o 4- <br /> e "-. OyL A oti7 - <br /> 12. SENSOR 13.This Is to Derlity,that these tank system,ware tested on the delete)shown.Tinge Indicated Ise Mqh'meat the alt.rr established by the <br /> CERTIFICATION National Fire Protecmn Association Pamphlet 329. <br /> a - fI <br /> �y� <br /> Dat. , y <br /> &3/n- 9.J7 y Tesnng C rn,...,or comped'. By: SlMpux <br /> satlat l�Tnatmr cenInurron� —y A2 39 Gam/ LS 0-97"p."1004-0 <br /> Aedrw <br /> cene�cano�e <br /> PNeea <br />