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WORKSHEET FOR SUBMITTAL TO GOVETtNMENTAL AGENCY <br /> y <br /> OWNER/OPERATOR S • �' L SITE ADDRESS <br /> CITY S COUNTY c, A ,,a mat. K) <br /> MAILING ADDRESS ' O Q 6 p J Q,s2_R-y3G6L D _-- -SITE AGENT TELEPHONE 9<63- •412-0 <br /> ARRIVED TEST 51'iEy Q!;)1OURS TANK LOCATION/NUMBER-A.2j.e bE jC5 f'1j_pQLE TrWIC <br /> � ,�� .ob <br /> DATE/TIF¢ STORAGE FILLEQ 1Z.1 4 ' PROTIITCC LEVEL AT dARIVAL�L..Sr1NCF{ES BELOW TOP OF FILL. NOMINAL TANK SIZE <br /> TANK MATERIA ? APPROX. AC&IXWYRS. FILL SIZE/TYPE + OVERFILL OONTAINFENT TYPE �0�� - <br /> API GRAVITY 5'7.cLAT 5 S DEC. F. - API GRAVITY OFf.,,!?.i2I 6DF - COEFFiCIFNT OF EXPANSION OF: -0014 Z - COE OF-L- C <br /> VTSABIE VENTING APPEARS TO BE AT: ILL END, FILL OPPOSITE END, HAS BURP TUBE, UNKNOWN, HAS A BALL CHECK, OTHER <br /> VISABLE VAPOR TRAPS TO BE BLED: BALL CHECKS, ANWdYS OTHER <br /> PHASE II VAPOR RECOVERY SYSTEM TYPE.lci HCp' ASPIRATOR ASSISTED LONG RUN HELLS KANIFOLDED NONE OTHER <br /> PUFiPlNG SYST 1: SUCTIONINE HAKE MODEL tLP) PIPE LINE LEAK DETECTORS L.Jn <br /> zwe-'_ rJAN •*•y 2L—SYSTEM <br /> CHARTED TANK SIZE i��ESTIHATED LINE QUANTITY40 PRODU/-CT ADDED TO FLOOD SYSTEM— GALLONS TOTAL 12-0 Z y <br /> AMBIENT WEATHER CONDITIONS: TEMPERATURE PRETEST� '4POST TES1SU1VN RAINING CLOUDY WINDY NIGHT OTHER <br /> SYSTEM FLOODED 5 HOURS .4 PSi DROP .HOURS PSI TO RE MAINTAINED ON TANK BUMM DURING TEST PERIO <br /> A. GRADE TO TANK BOTTOM <br /> GRADE TO TANK TOP <br /> O LdL.�4 C. TANK DIA%WTER <br /> D. TEST LEVEL ABOVE GRADE <br /> E. EXTERNAL GROUND WATER ABOVE TANK <br /> E e <br /> BOTTOM�fa_It&. X .0561 PSI • <br /> F. TOP OF FILL TO PROD. AT ARRIVAL <br /> G. TOP OF FILL TO TOP OF TANK 47 <br /> H. TEST 7,EVEL'TIT BOTTOM OR TANK f <br /> • C PSI PER INCH OF PPADUCP <br /> WATER I S DE <br /> TANK " - TEST HEIGHT PRESSURE FDRFKTLA <br /> ret ! X .g).b+ <br /> H. PSI E. PSI NET PSI <br /> REMARKS : , �l�o '� z-o � l `STAki C17'�nTn Trfi� V E.7S Pipes �(] t?,i: l It1 ENh A f� -� ' 1. r - <br /> tA\.)t;L. Awn Al A `i S L- t. Q.Li�OnQt;D vUNn AW20 ve e7D <br /> THE FINAL TEST PERIOD AS SHOWN ON THE ATTACHED COMPUTER GENERATED DATA REFLECTS A <br /> LOSS / CATN OF:-�i9.3GALLONS PER HOUR, WITH A 99% CONFIDENCE LEVEL OF +/- , 00 GPCI. <br /> USING TME TIORNER EZY CHEK II METIiOD OF TESTING THE RESULTS AS SHOWN ARE TvT7fTN / <br /> NOT TVTTHIN TI{E STATE OF CALIFORNIA AND VIE NFPA 329 GUIDELINES OF A MAXIMUM LOSS OR <br /> GAIN OF .05 GALLONS PER HOUR FOR A TANK SYSTEM TO BE CONSIDERED TIGHT. <br /> INTEGRITY•TANK TESTING SYSTEMS, INC. 166 FRANK WEST CR. <br /> STOCKTON, CA 952061,(20 ) 466-8036 or (800) 262-8378 <br /> W <br /> CERTIFIED TESTER - TEST DATE /Z- j7� �� <br />