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DATA CHART FOR TANK SYSTEM TIGHTNESS TEST <br /> (M CHEq <br /> CRISP Wit TMIRCSMOOM CA 95M <br /> {,t04J l3kli2>t <br /> NAME OF SUPPLIE ar. I }�, <br /> OWNER OR DEALER � y �O b J—r'I r'IJ DATE OFT-c5- o') ` TT 'START 00 TIME FINISH 2/dOLENGTH CF TEST,;- <br /> ADDRESS <br /> EST -ADDRESS(NO.3 STREET) I WEATHER TEMPERATURE�45 <br /> CITY AND'STATE <br /> TANK INFORMATION <br /> CAPACITY(NOMINAL) GALS. Sim OF FILL OR i r-S'a OPENING y IN. CON t=NTS(PRODUCT) <br /> CAPACr Y(CHART) GALS. TOP OF=TIME HOUR//4C DA7E/a;jj-9 L GAI!CNS . 03a TANK MATERIAL-ME-AL OC) FIEZ;%Afc( ) <br /> DIMENSIONS_ DIAMETER NUMBER OF GALLONS A00ED TO 5TAF;T—ir_S L _ APPROX.AGE <br /> LENGTH TANK NO. f r7U c SUB(. ) rtAKc <br /> PUMP SYSTEM-YP_ <br /> - INC'-"._S Or WATER - BEFORE Ti-ST AF.cR T EST SUCTION <br /> LERK OE T ETTT}R YES }C NO <br /> TEST CALIBRATION ra�K-+YGUT VAPOR PECOVERY Svc.-H Y=5(X NO( <br /> SIZE OF CAL BAR OR ML'S AICC•ED . o5 - .�S. 041 c{ <br /> ' _��_ ... .PHASE 1 (7Q PHASE 2 {�[) <br /> I�""A� IFk�.+A1 OVERSPILL CONTAINER YES( )NO(�C) <br /> UNE MOVEMENT <br /> 1 t0 LINES <br /> SHEAR VALVE YES{x) NO{ ) <br /> �� _ <br /> 2 5 to 7 g - LINES COMMENTS <br /> 3 `f`I to 2LINE5 a 3 _7 <br /> TOTAL s �/ LINES -3 = LINES <br /> (ALM) <br /> END OF TEES, CA "BRATION <br /> $iL Or CAL BAR OR ML'S ADDED O� - 3-3. fJ/q8- - j ��ry - - - <br /> LINE MOVEMENT q � tl <br /> I to v 3 "3 L-NEO <br /> 2 to LINES DEC3 to ? _ L:N_c C p 3 1993 <br /> ,,-AL /0/ _.LINE_ - a '3 L t - -L;NEI <br /> IALMI <br /> MEASURED ARI SPECIFIC GRAVITY S ENVIRONMENTAL HEALTH <br /> PRODUCT TEMPE.RA.TUR! P PERMIT/SERVICES <br /> API SPECIFIC GRAVITY*500 F (FROM rA3LL A) <br /> COE==ICIENT OF EXPANSION r (P-ROM TA 3L:- E) <br /> .000 X 900 _VA4rRE) <br /> God roraL :r <br /> caracr Icau VOL GwuvG�,'F <br /> COMMENTS- <br /> OWN_R Or: SITE ADDRESS <br /> CITY STATE ZIP CODE <br /> OWNER OF' TANK AOORESS <br /> CITY STATE ZI_P LODE <br /> COUNTY <br /> r" <br /> TECHNICIAN(S) DATE <br />