Laserfiche WebLink
a <br />_ I 0 <br />f o f„ <br />W Vl <br />� o � <br />7 CONTRACTOR OR COMPANY MAKING TEST <br />MECHANIC(S) NAME ':i)C-a <br />I IS A TANK TEST TO BE D YES B MAKE AND TYPE OF <br />MADE WITH THIS LINE TESTI <br />LL LJ NO PUMP OR DISPENSERS <br />e� CuS[ lli(1(h� COVER t. u APPROXIMATE <br />10 WEATHER <br />TEMPERATURE IN TANKSY�'f 'C OVER LINES �K C�C /Q 1t4 [, BURIAL DEPTH I <br />Concrete. Black lloo. sic. <br />11 IDENTIFY12 <br />EACH LINE <br />AS TESTED <br />TIME <br />(MILITARY) <br />13 LOG OF TEST PROCEDURES, <br />AMBIENT TEMPERATURE, <br />WEATHER, ETC. <br />14 PRESSURE <br />15 VOLUME <br />16 TEST RESULTS <br />pal OA kPa <br />READING <br />BEFORE AFTER <br />NET <br />CHANGE <br />CONCLUSIONS, REPAIRS AND COMMENTS <br />BEFORE <br />AFTER <br />.__.DATA CHART <br />ICA �.Cy <br />1J K-�.G � 4, C <br />•�-a25 <br />For Use With <br />PAqrg tP <br />, <br />43 <br />ro2�5 <br />0 � <br />1 LOCATION: I <br />lD laY <br />© (5 <br />4's <br />t U 2 u <br />„°Cr. <br />n or)CD <br />Sliest No, end/or COrnerClry <br />State <br />Telephone No. <br />• <br />Z <br />• <br />�r(` <br />Q 4� <br />/ <br />p <br />2 OWNER: <br />o <br />NkrrN AddressReDresenUUve <br />Position <br />Telephone No. <br />SU <br />1 OPERATOR: <br />(� <br />Yr& AS P-,uer <br />45 <br />D2 J'C:� <br />R-eme Diner, Mgt. or Other <br />Address (II different the�Locatlon) <br />Telephone No. <br />o2 <br />D-215 <br />,00 <br />4 REASON FOR TEST _ --- <br />, I �l F CS� 4f12 <br />r <br />z <br />J113, <br />a Y <br />F <br />H <br />6 TEST REQUESTED BY: <br />L <br />Name Position <br />O <br />J <br />OrOer No. 9141 p Address <br />- <br />6 SPECIAL INSTRUCTIONS: <br />— <br />a <br />_ I 0 <br />f o f„ <br />W Vl <br />� o � <br />7 CONTRACTOR OR COMPANY MAKING TEST <br />MECHANIC(S) NAME ':i)C-a <br />I IS A TANK TEST TO BE D YES B MAKE AND TYPE OF <br />MADE WITH THIS LINE TESTI <br />LL LJ NO PUMP OR DISPENSERS <br />e� CuS[ lli(1(h� COVER t. u APPROXIMATE <br />10 WEATHER <br />TEMPERATURE IN TANKSY�'f 'C OVER LINES �K C�C /Q 1t4 [, BURIAL DEPTH I <br />Concrete. Black lloo. sic. <br />11 IDENTIFY12 <br />EACH LINE <br />AS TESTED <br />TIME <br />(MILITARY) <br />13 LOG OF TEST PROCEDURES, <br />AMBIENT TEMPERATURE, <br />WEATHER, ETC. <br />14 PRESSURE <br />15 VOLUME <br />16 TEST RESULTS <br />pal OA kPa <br />READING <br />BEFORE AFTER <br />NET <br />CHANGE <br />CONCLUSIONS, REPAIRS AND COMMENTS <br />BEFORE <br />AFTER <br />ICA �.Cy <br />1J K-�.G � 4, C <br />•�-a25 <br />8 " <br />43 <br />ro2�5 <br />0 � <br />—r o025 <br />© (5 <br />4's <br />t U 2 u <br />to -25b <br />n or)CD <br />g ,o <br />• <br />Q 4� <br />/ <br />SU <br />45 <br />D2 J'C:� <br />o2 <br />D-215 <br />,00 <br />