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WORKSHEET FOR SUBMITTAL TO GOVERNMENTAL AGENCY <br />OWNER/OPERATOR Q �' T���%+� �7 SITE ADDRESS 75 <br />CITY J.64G j/ Comm J -Ax..) tTO�Qc1l�1 <br />HAILING ADDRESS <br />SITE ACENT TELEPHONE <br />ARRIVED TEST SX67-y�ROURS TANK LOCATION ^lO /,� �G,��•' T PRODUCTDATE/TIME STORAGE FILL;D' � 1� PRODUCT LEVEL AT ARRIVAL INCHES BELM TOP of FILL NOMINAL TANK SIZE <br />TANK MATERIAL 7 AFPRox. TANK AC?. -?74 <br />�j TRS. FILLSI7.E/Y7FE_ OVERFILL CONTAiNN/m TrrE <br />APT CRAVITT AT�3 DEG, F. ATI CRAViTi OF f 6OF - COEFFICIENT OF EXrANSioN OF .000 7'-� 4 - cot <br />VISABLZ VENTING APPRFARS TO BE ATi FILL END, LL OSITE ET RAS BURP TUBE, RAS BALL CHECK. UNKNOWRT. OTHER <br />VISABLE VAPOR TRAPS TO BE BLED: BALL CHECKS, MANWAYS, RETURN LINES, OTHER <br />PHASE II VAPOR RECOVERY SYSTEM! BALANCED. ASPIRATOR ASSISTED, LONG RUNGrgELLS, HANIFOLDED, ONE, OTHER <br />PRJFIPLFG 5TSiEtt, CTION TURBINE HAKE i/�� HODEL7- 5 PIPE LINE LEAK Detectors TES, IM. T, T <br />CHARTED SIZE `li ZQ EST. LINE QUANTITY PRODUCT ADDED TO FLOOD SYSIER -57 ".STEM TORAL GALLONAGE «i <br />AMBIENT CONDITIONS: I PRETEST 00 F//,O.SUNNI <br />STTEST SCLOUDY. RAINING, HIND BREEZY NIGRT, OTHER <br />i <br />.4 PSI D HOURS TEST TO START/Aq!HOURS PSI TO BE MAINTAINED ON TANK BOTTOM DURING TEST PmloDP3t <br />A <br />4/7/4 f/4 <br />. �� To Tu+K eoT7DN <br />D ZD B. GRAM TO TAMC TOP 4% <br />C. TANK DINArMR <br />677x- <br />7 D. TEST LEVEL ARM GRADE <br />An E. EIRERNAL GROUND MATER ARlOVE TALAR <br />�j -- 1 �- BOTTRI iM. x .0351 PSI <br />r. TOP OF 'FILL TO PROD. AT ARRIVAL <br />G. TOP OF FILL TO TOP Or TMt Q <br />H, TTiST:, SM-TilOTTOR OP TANK f <br />MATER [N OE C PST PER INC" OF PIODUCP <br />{' E TANK • _ f TEST HEIG!!T P"-SSMFOR lftA <br />: i ,� h/�`Z!� �p�rCJ� f �- ��� N PSI PSI NET P51 <br />REtWKS <br />RESULTS <br />THE L TES'r PERIOD AS STIOWN ON THE ATTACHED COMPUTER GENERATED DATA RrFI,ECTS A <br />LOSS / 6A OF: Lt)& GALLONS PER HOUR, WITH A 997. CONFIDENCE LEVEL OF +/- ,.J90 / gph. <br />THE HORNER EZY CHEK II T T METHOD COMPLIES WITH EPA AND THE STATE OF CALIFORNIA PERFORMANCE STANDARD OF 0.05 GPH <br />FOR TANK INTE G. SECTION 2643 CALIFORNIA CODE OF REGULATIONS) BASED UPON THIS STANDARD, THE RESULTS <br />SHOWN ABOVE: 1;rES NOT INDICATE AN UNAUTHORIZED RELEASE EQUAL TO OR GREATER THAN THE 0.05 GPH STANDARD. <br />INTEGRITY TANK T TIN V'ICIE,S, 41 WEST YOKUTS ST. STOCKTON, CA., 95207, (209) 474-1375 or (800) 262-8378 <br />CERTIFIED TESTER L%CryV � STATE LICENSE A Z�/f� Z-cT TEST DATE <br />