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. • i <br /> Data Chart for Tank System ightness Test <br /> petro TA-ch <br /> TANK TESTER <br /> PLEASE PRINT <br /> 1. OWNER Prop.ny Ij _,l94x n <br /> Name <br /> b <br /> nk• CJ <br /> Name <br /> Aad,. Raproamnlra iaHpngn. <br /> 2. OPERATOR No. Address al.pnona <br /> 3. REASON FOR' <br /> TEST <br /> (E.plain Fully) <br /> 4. WHO REQUESTED �T J11 L'Tb/q <br /> TEST AND WHEN Nama Tin. Company.,Auu.dim Dote <br /> Add.... T.I.pnon• <br /> 5. WHO IS PAYING <br /> FOR THIS TEST? Company.Agency or Individual Person Aemel.g Tale Trillion... <br /> Billing Address City St.,. 210 <br /> Attention of: Order No. Omer Institutions <br /> Identify by Direction Capacity Brand/Supplier Grad• Approx.Ago Sud/Fiberglass, <br /> 6. TANK(S) INVOLVED <br /> N79T<1 717,lEft /d 1S� <br /> T6_1006 /CEL <br /> o�TH /s-; 000 i_A ,z_�L /, <br /> Location Cover Fills Vents Siphons Pumps <br /> 7. INSTALLATION �°i^<- /,; n�jl 1,7rt4 7 <br /> DATA <br /> North inside drlr.wq. Concrete.BI•ck Tod. Size.Titafill make.Drop Suction.Remob. <br /> Rea,of sl•doa.11. Esrtn.etc. luou.Remark Fill. Sh•.Menllolded Which look.? Make it known <br /> 8. UNDERGROUND I.the were,ever the lonkir <br /> WATER Depth to the Water table 13 Yes El No <br /> Tanks to be filled hr. Data Arranged by <br /> 9. FILL-UP Name rel.pnp^• <br /> ARRANGEMENTS E.U.Product to"top orf'and run TSTT. How and who to provide) Consider NO Lead. <br /> Terminal or other contact <br /> for notice or inquiry <br /> COrnOenY Name T.LOnne <br /> 10. CONTRACTOR, — <br /> MECHANICS, <br /> any other contractor <br /> involved <br /> 11. OTHER <br /> INFORMATION _ <br /> OR REMARKS <br /> Additional information on any items above.Officials or other.to be advised when toting is in progress or completed.Visitors or observers p,e.em <br /> during lost.11. <br /> Tests were made on the above tank systems in accordance with test procedures prescribed for Pp <br /> rt }FO Tf}p <br /> 12. TEST RESULTS as detailed on attached test charts with results as follows: ' r3 <br /> Tank identification Tight Leakage Indicated Date Tested <br /> 13. CERTIFICATION Thls Is to certify that these tank systems were tested on the date(s)shown.Those Indicated ss"Tight"meet the criteria established by <br /> the National Fire Protection Asoclation Pamphlet 329. <br /> Oat. �T Lawrence Tank Testing <br /> P.O. Box 407 By: Signlur. <br /> Sanal No.of Thermal T.cnn,cuns Downieville,California 95936 (916) 289-3109 <br /> So.. <br />