Laserfiche WebLink
Data Cert for Tank System TightlOss Test <br /> petro Tate <br /> PLEASE PRINT V77—TESTER <br /> 1. OWNER yrpwnv ❑ Al 2 ( N <br /> Nam• <br /> Tsnk(s) ,� - °� wuarounv LNonane <br /> N.. Add,. &rorrouum• taroMM <br /> 2. OPERATOR nli f <br /> Nona A°dr•v TN•aheM <br /> 3. REASON FOR r <br /> TEST <br /> (Eapl.in Fully) — <br /> 4. WHO REQUESTED <br /> TEST AND WHEN """' Tip• L'amgeM or Auw On <br /> D.t. <br /> A°°rna linion.. <br /> 5. WHO IS PAYING mod <br /> FOR THIS TEST? COmwny.Agency or Individual Perron Amnen.ln■ Till. L4ohen• <br /> BImM A°°rns Clry Suu Zb <br /> All• .al: OrEa NO. Oln•I InalluCrlOM <br /> Identify by Direction Laweiry Brand/SupplierGrad* Apwoa.Ap• beryl*. <br /> 6. TANK(S) INVOLVED -5-006n,/ S 2 tffe� <br /> Location Cover Fills Vents Siphoms pumps <br /> 7. INSTALLATION Nett s-v <br /> DATA Fvtf rack 841yr-Top qfr 2 ;n n0At no n.L <br /> Nann IMb•YrNawq. CancnM.Wct Tne, Sir*,Tlbrlp iMN.Drop <br /> PSuawn.ll•mou <br /> ur or unt <br /> a .,MC Wall,ata. tao•a q•mou Fled Sha.M•Mtols, Which t,nb I Mak*it knave <br /> 8. UNDERGROUND is the wet"over the tank) <br /> WATER Depth to the W.I•r tall._- <br /> 9. FILL-UP Tanks to be filled_hf, Data Arranged by <br /> N•m• TN•p110M <br /> ARRANGEMENTS E.be wedua m"too orf"and rvn TSTT. Now and who to provide 7 Consider NO Lead. <br /> Terminal w other contact <br /> for notice Or inquiry <br /> C°Tp•M NNn• }•IaaMM <br /> 10. CONTRACTOR. <br /> MECHANICS. <br /> my other gontra°tw <br /> involved <br /> 11. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> Additional iniwmabon on any iums*bow.DIflClal*or the, to <br /> during lea ere. be•dvis•d when omni is In prggr•.a or compla "ed.Vivian or observers wase <br /> Tests were made on the above tank systems in accordance with test proCedures prescnbed for Prfro TIf <br /> 12. TEST RESULTS as detailed on anached test Chan&with rosults a follows res— <br /> L• <br /> Tank Identification Tight Less 9•Indicated Dat*T•n*d <br /> o l t n P/+.- ✓r / - 3-90 <br /> 13. CERTIFICATION TAIs la to cena lty that thetank eyatete(q ma wen tested on the dashown,Thomas, <br /> Indicated as 'Tight"Treat the Criteria established by <br /> the National Fla Prcta lon Asoelatlon Pamphlet 329. <br /> _.i�qz—/339 Lawrence Tank Testing <br /> P.O. Box 407 <br /> S... gnaul <br /> 5. a"° aTh.ma .ane.,... Downieville,COlifornia95936 (916) 289-3109 <br />