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—• --- - —••• •• • v•• 5ll11l� 401�1 VMM1 <br /> � CHEK <br /> LI�1 1 IL7I7 / I�GJJ 1 LJ1 <br /> Y ) <br /> Tie m11e q /mODIKT ON IOOup A lE)FER QUiE DOYP13i5ATpN 11 NET IOL lam» MI. hie 1 t Flet A .� elln 6d 4 M x Faea a fon bd 1t Am=a .� UR <br /> 6e sS :003 ,o S -o/ :00 ,2 <br /> �S 61 So '1) , 1 :6}c• o e' g +003 6.o ,5 :039/ <br /> so µc roezy q 7e1c 6C,a o.?.S9 �o6t E o �060 -o3S� <br /> 40 30 0 Ot 7e, ?0 E6.aSy 6i''. 5 .PC,1 — <br /> 1 F 0060 - <br /> s' C 60, S� -ocr 6.oES -A�Eq er3c <br /> �� io cei n� o ba s + el 6-c 006o c11r <br /> �n�SO <br /> our `0� or r 6,65S '!ocer -0 3! <br /> oral 215 Se ,00r C.Cgs �oe6t -ol/ f <br /> to 60 53 70133 6o,asd ash -onr cBs =cn6c :��3 <br /> °sr 11 5 46 0133 <br /> " U6 :,-133 Ea 1s c,a53 -ovr E.o =noEG :00 3 <br /> �a 3 3 33 -6 r �6r1N �.d53 252 -,-n ES -0060 <br /> S 90 -S o09 -0095 6r 2s} c.25/ -a6( 6.e ,006`x' 0035 <br /> '9ts4o P 6 �cr9 ,o lu L 2si 6c7u oc3 <br /> 16 6. _vl oco9 <br /> w ��� <br /> 6c. - -0035 <br /> bo-?4b � .'oor E 0060 <br /> 2 66 _C cur -ally 66.;46 k,;-4S 00 E-0 'S .0 0 coS <br /> s ry 6E O -6 , -orl 66. ;tu - �c. 3 :6c2 „c .ala- _ <br /> �L -C aua �ocr 6 065 -0060 �oa3S <br /> , <br /> IFA. Tank Bot. to Grade 13 9 <br /> B. Tank Top to Grade s - Send Report to: <br /> C. Tank Diameter ��- Client "� g <br /> D. Test Level above grade _- Address sei w�6c0% �vf. <br /> E. Depth of water in tank o City, State c o0; CEJ �Sa p <br /> F. Depth for taking sample 9a- P fin. <br /> H G. Temp. Probe depth (connector) •A H. Test level to Tank Bot. �"""` 'OiOM '"°s'°1. Groundwater above tank bottom w 1°•"��•��"•+^�^�,rJ. Product Pressure per 1' height SSI Tank Nom oE� ,, e.ER <br /> Test Pressure Formula gDAG6 6s gc c, 6_( �.X�z . Leakage Indicated - <br /> X_� Technicians' R r;zuGcfbul°S <br /> ~ ' 1 S <br /> WT nm Date Tested a. 90 <br />