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j��r� - <br /> Data Chart for Tank System Tighi �st <br /> Il`' JUN 14 1988 <br /> PLEASE PRINT <br /> 1. OWNER Pppwyq O% 7 41 00 6 ( IT/SERVICES. <br /> Ws mAndress Replaeentetive Telephone <br /> Tenk(a <br /> Nemo Address Representative Telephone <br /> 2. OPERATOR Name Address Telephone <br /> 3. REASON FOR <br /> TEST 0 hq--4 46oj <br /> (Explain Fully) <br /> 4. WHO REQUESTED tiZ <br /> TEST AND WHEN "'"" Tale OgrhparywArgument Data <br /> Add. Telephone <br /> Identify by Oiremion Capacity Brand/ ,xibller pGr.d. Approx.Age Steel/Fiberglas <br /> 5. TANKINVOLVED pd T EWeeed ftb lines / rfor meMbloed tanksLocation Cover Fills Siphones Pumps <br /> 6. INSTALLATIONDATA (� <br /> North Insidedriveway. Concrete,Bleck Top. Size.es Re make.Drop Suction.Remoat. <br /> Rearof eMbon,etc. EeM,etc. tuba,Remote Fllla Size,Manlblde0 Which tanks? Mska H known <br /> 7. UNDERGROUND Is the water over the tank? <br /> WATER Depth to the water table ❑yes XNo <br /> Tonka to W filled hr. Data Arranged by <br /> B. FILL-UP Nemo Telephone <br /> ARRANGEMENTS Extra product to lop mP and run tank tater. lbw and who to provide? Consider NO Lead. <br /> Terminal oI other oonum <br /> for nedoe or inquiry <br /> Company Name TNeplwns <br /> 9. CONTRACTOR, N <br /> MECHANICS, <br /> any other contraQor <br /> involead <br /> 10. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> Additional Information on any items above.Officials or others to be advlad when testing at In progress or completed.Vlakon or obanars present during tett.No. <br /> Tata were made on the above tank Systeme In accordance with test procedures prasalbard for <br /> 11. TEST RESULTS as detailed on attached test Marts with hall as follows: <br /> Tank identification Tight Leakage Indicated Data Tested <br /> CC / JZ '.O S <br /> z tar <br /> 12. SENSOR 13.TMs Is to certity that mese tank systems were tested on the dah(s)Mown.Those Indicated as"fiphr meat the olteda s stablished by the <br /> CERTIFICATION National Fire Protection Association pemphlet 324 <br /> Taring Cpntracbr or CoIrIWIY. BY: Sipl <br /> o. <br /> $ental Nof Thermal CMlficati co 'i ; g <br /> $Mgr LA6/� <br /> Address <br /> 2 <br /> ' <br /> Certification It <br /> PNSB2T <br />