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Data Chart for Tank System Tighlitass Test <br /> petro Tltea <br /> �y' p s /- <br /> T5TT <br /> [1 �,..�1 <br /> 1. OWNER Props y L7 ��M1' ��a [o26� 144 V JtilM[Lr S WIJ on. <br /> -- <br /> Aadreaa <br /> Tackle) Name STT04I _— __- -- Telephone <br /> Name N/ I[ Address <br /> 2. OPERATOR CSROW Al A �--• ss <br /> Name T dress <br /> 3. REASON FOR TEST l!"Iwr _ E"NVRCNNENTALHEA�L?H <br /> - pNyua�� 2Fak - <br /> (Explain Fully) <br /> 4. WHO REOUESTEDCu <br /> Company or Dale <br /> TEST AND WHEN —Name Title <br /> ---- Address Telephone <br /> 5. WHO IS PAVING X pg—PAG nne — Telephone <br /> FOR THIS TEST? Company,Agency or lntlivldusl Person Authorizing <br /> city state Zip <br /> Billing Address <br /> Attention of Ortler No. Other lnsiructiona <br /> r• Identify by Direction Capacity Grade Approx.ABe SteellFiberglasa <br /> 6. TANK(S) <br /> __1.00C) �_ _• u�I�ALTEp ? S+� E(LJaIJ <br /> 7. INSTALLATION Location Cover Fillg veins Pumps <br /> Snnons <br /> DATA �1I,� <br /> Nonway.li Inside duvhConcrete,Black IOD. Slee T,OIII make.gidD Su <br /> Rear of station,etc. Earth,etc. tubes.Rerndle This Size.Mamlaldetl Wks the <br /> tanks Maakkee known, <br /> 1 I1 known. <br /> I <br /> Is the water over the tank? <br /> B. UNDERGROUND <br /> Ely <br /> WATER Depth to water table II known— -" —( //k CeNo <br /> �s <br /> 9. FILL-UP Tanks to be filled��1_Data Arranged by .TIk� 0efIE <br /> ARRANGEMENTS Name Telephone <br /> Hour Cf;40 AM <br /> 10. TECHNICIANS � q �D <br /> 11. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> obaervare present <br /> Additional information on any Items above.Officials or others to be advised when lestinq is in progress or completed.Vbltors or <br /> during test,etc. <br /> Tests were made on the above tank systems in accordance with test procedures prescribed for Pp77M <br /> 1 Z TEST RESULTS as details on attached test chart with results as lollaws: 1 <br /> Tank Identification <br /> Identiication Tight Within Tolerance Out of Tolerance Date Tested <br /> U4. f <br /> 13. CERTIFICATION This is to certify that these tank systema were tested on the debts)shown.Those Indicated as--Tight"meat the criteria established by the National Fire <br /> Protection Association Pamphlet 329. <br /> 3 Name of person certifying <br /> CT <br /> Dab o �dAgm <br /> — — <br /> Teslin Contr or any. By./'`�_�,��--- _ _ ALo�41�13l�� 351 n�• BEp�rHA�I �__ rLG <br /> Serial No.of Thermal Sensor � Certltcalion Number <br /> Address <br />