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_ Data Chart for Tank System Tightness Test <br />PLEASE PRINT STATION tQ t _ 1 3 DATE <br />f <br />I. OWNER fioperty ❑ <br />Twit (s) F-1 rNerne, Address <br />12. SENSOR <br />CERTIFICATION <br />Date <br />Serial No. of Thermal <br />Sensor <br />13. This Is to oarWy M these tank system were MNed on the date(*) showr>_ Those Y+dlcagd ar.'ngW nwN the «Marta eetabl shied by the <br />National RM proliseft Association Pamphlet 329L <br />Teen <br />t. <br />Cenificahon a <br />2 <br />Certillcation I <br />SCOTT- CO - <br />Testing I"*.or Company. By: Spnatun <br />1919 42uT �r DbyLA9 , CA. <br />Address <br />PN6827 <br />PAWMsentatire <br />TMephom <br />Nems Address Representative <br />Telephone <br />2. <br />OPERATOR <br />Name � Address <br />Telephone <br />3. <br />REASON FOR <br />TEST <br />(Explain Fully) <br />�. <br />4. <br />WHO REQUESTED <br />TEST AND WHEN <br />Na" Title CornpeM or Affiliation <br />Date <br />Adds <br />Telephone <br />5. <br />TANK INVOLVED <br />Lbe additional lin« <br />for manitdded tanks <br />Identity by Direction <br />Capeeity <br />gra liar <br />Grade <br />Approx- Aye <br />Stee Mberglaes <br />6. <br />INSTALLATION <br />DATA <br />Location <br />North inside driveway, <br />Rear of station, Mc <br />Cover <br />Concrete. Top. <br />E Mc <br />Fills <br />Size. Titelill e, Drop <br />tub. R Fills <br />tubes. <br />Vents $?phots <br />Size, ManifoldWhich tanks? <br />ptanps <br />Suction, Remote. <br />Make d known <br />7. UNDERGROUND <br />WATER <br />Depth to the W.I. tai. <br />/ V <br />Is the water over the tank? <br />❑ r« ❑ No <br />8. <br />FILL -UP <br />ARRANGEMENTS <br />Tanks to be filled <br />Extra product to "top ofr <br />Date Arranged <br />run tank taster. How awho to provide? Conti N <br />ro O Lead <br />Name <br />Telephone <br />Terminal or other wy <br />for notice or inciviry <br />Company fame <br />Telephone <br />9. <br />CONTRACTOR, <br />MECHANICS, <br />any other contractor <br />involved <br />_ <br />_ <br />10. <br />OTHER <br />INFORMATION <br />OR REMARKS <br />Aional information on any items above. Officials or others to be advised when testing is in progrw completed. Visitors or observers present during test. etc <br />11. <br />TEST RESULTS <br />Tests were made on the above tank systems In accordance with test procedures <br />se deta"d on attached test charts with results as follows. <br />Tank Identification Tight Leaxage Indicated <br />bed for <br />pate Tntad <br />12. SENSOR <br />CERTIFICATION <br />Date <br />Serial No. of Thermal <br />Sensor <br />13. This Is to oarWy M these tank system were MNed on the date(*) showr>_ Those Y+dlcagd ar.'ngW nwN the «Marta eetabl shied by the <br />National RM proliseft Association Pamphlet 329L <br />Teen <br />t. <br />Cenificahon a <br />2 <br />Certillcation I <br />SCOTT- CO - <br />Testing I"*.or Company. By: Spnatun <br />1919 42uT �r DbyLA9 , CA. <br />Address <br />PN6827 <br />