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WORKSHEET FOR SUBMITTAL TO GOVERNMENTAL AGENCY <br /> OWNER/OPERATORPie.I'L i►1.1FLS LQdP---SITE ADDRESS 12iia <br /> CITY T c c*-) COUN'T'Y <br /> MAILING ADDRESS E= <br /> SITE AGENT- �4 V-g 9,4,E r 5 TELEPHONE Cjo,)) ci <K -•41 2�0 <br /> So <br /> ANIIYED TEST srnuQlq- s TANK tocnioN/NUMBIBR to --Vh4V– c�H <br /> dRODHRT V {.. <br /> DATE/TIME STORAGE FILLED 12-11 I I� oRODIlGT LBVELL�ATTr"ARRIVAL til HCHES BELOW TOP OP FILL. NMOPIAL TANK SIZE /2,©Up <br /> TANK MATLRIA4 5—lr, APPROx. AGLY�,]RS. FILL STIVIWIL—� DVMRPTLL CONTAINMENT 17" 1.301 16 <br /> APr CRAv1TT°5-7•� ATS--7 Dec. F. - API GRAVITYOfSL2B 60F ■ COEFFICIENT Of EXPANSION Of: .nM inQ192- • COE OF—L tL L <br /> VISABLE VENTING APPEARS TO BE ATIEND FILL OPPOSITE END, HAS SUMP TUBE, UNKNOWN, HAS A BALL CHECK. OTHEL� <br /> VISAIILE VAPOR TRAPS TO BE BLED, BALL CHECK4AT OTHER <br /> PHASE If VAPOR RECOVERY SYSTEM TYPE J16ANOID ASPIRATOR ASSISTED IANC RUN WELLS MANIFOLDED NONE OTHER - iC5 iaye V L3szF <br /> Fllmm smim! sUCrrf!(`DIAIH� MAKE LII u -yTAj-W7 _MODEL H,ip. PIPE LINE LEAK DETECTORS ()N <br /> CHARTED TANK SIZElfiijiESTIMATED LINE QUANTITY RODUCT ADDED TO FLOOD SYSTEM99YsYEN GALLONS TOTAL/d:pf6 <br /> lby� <br /> AMBIENT WEATHER CONDITIONS* TEMPERATURE PREIBSTU*CST TBS RATNING CLOUDY WINDY NIGHT OMR.- T-Df.$y �} Q <br /> SYSTEM FLOODEDl6f40 HOURS .A PSI DWPl=HOURS PSI TO BE MMNTAIMBD ON TANK BOTTOM DUt11NG TEST PERIOD T/ v <br /> A. CRAM TO TANK BOTTOM <br /> O 3 T B. CRAM TO TANK TOP 5 Li <br /> C. TANK DIAVMR ' <br /> 6.Pi1AE <br /> D. TEST LEYEt ABOVE GRADE I <br /> E. EXTERMALL G WATER ABOVE TANK <br /> surrum I*. x .0]61 Psi <br /> P. TOP OF FILL TO PROD. AT ARRIVAL <br /> G. TOP OF FILL TO TOP OF TANK L 3 <br /> R. TEST:4.SM'TD Ti0T7OlI'DB TANK���� r 1V2— <br /> psi <br /> 9 2— <br /> Psi PER IMO[ OF PIbDDCr rlUZlo� <br /> 7WATER TNSIDE <br /> - TANK - TEST HE1OfI PMESSURE FORMUI 1 <br /> E l <br /> H. PSI B. PSI NET PSI <br /> REMARKS' 00-ower t GVCL T`!L 41" PlEt- UL kn-WG +,IA 0wlV <br /> sSso ��a1 LF1_L�(-r'S � moss o �, - <br /> Lk'. 4W 4_ C.C�►3 ISI Por J2 1 P uOD <br /> i- <br /> + <br /> THE FINAL TEST PERIOD AS SHOWN ON THE ATTACHED COMPU'T'ER GENERATED DATA REFLECTS A <br /> OSS GAIN OF:-ry5 GALLONS PER HOUR, WITH A 99% CONFIDENCE LEVEL OF +/- ooq GPS{. <br /> USING THE HORNER EZY CH EK II METHOD OF TESTING THE RESULTS AS SHOWN ARE WITUIN / <br /> OT IN THE STATE OF CALIFORNIA AND THE NFPA 329 GUIDELINES OF A MAXIMUM LOSS OR <br /> .05 GALLONS PER HOUR FQR A TANK SYSTEM TO BE CONSIDERED TIGHT. <br /> INTEGRITY TANK TESTING SYSTEMS, INC. 166 FRANK WEST CR. <br /> STOCKTONM CA 95206 (209 466-8036 or (800) 262-8378 <br /> CERTIFIED TESTER f/Li/ QL— TEST DATE �� �' <br />