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Data 'C rt for Tann 5 s#em <br /> Y Tights ' Test _ <br /> pe�firy TitQ <br /> ' TANK TESTER <br /> PLEASE PRINT <br /> 1, OWNER Property � Rrrr sentatheY Tete9hona <br /> '4 e.m. Add ss <br /> Tank{s) a __ - --- —'�Rapseaantati.a Tdepnona <br /> Name f y r' /1 Address - <br /> ,1 J-•//1I1� � �Lf'��� �r - � � � 'r - TNeanons '. <br /> 2, OPERATOR Nam. Address <br /> 3. REASON FOR <br /> TEST ✓=;sl." 'T, <br /> (Explain Fuily) <br /> 4. WHO REOIJESTEO - --- -_— <br /> ------ — —-- ---- : ,,:,n <br /> Tate <br /> TEST ANO WHEN --- --.�. - <br /> 5. viHo IS PAYING - _— -- ---- - --=:r' - ;tl„�.,dn, <br /> Cnmpar*y.A;„n c7 or dndirv•^_:a: Parson Au:nnriainq <br /> M THIS TEST? — --- -- Zip <br /> --3ulin.lA�7t�+v ~- Car >ta:e <br /> Attenr.on 0R: Qldar No. Otnar In suucadns <br /> Identi <br /> 6. TA`K(S) fy by Oirvction Capacity Brand/Soot tier Grade Approx.Ase Steel;Fiberglass <br /> Iv`10LVE0 5 l L� E :_�,�f:' lir!.--�� /"L- [J �rr_- ,:w ='r 751 <br /> 'S <br /> LOrL riJn <br /> Covet His. Vents i Sipnones Pumps <br /> 7. INSTALLATION 4/ <br /> OATA 4.-;v <br /> 1 <br /> ' Suction.rlemul+, <br /> N coh inside d'ive's'•-e. concrete,31.1cv.T]p. 7+i:d.i i1e 1111 r:Y eke.D,ap <br /> Y.aar ui sta tiu n,n:r- it <br /> -earth,etc. to�.s.Ra:nu:a F!:;, S,.'t.r.ta nifulded i Y:1ich,an15? Maks kne,�n <br /> Is the water over the tank 1 <br /> 8. lJN9ERGRC;1J1NO <br /> WATER Depth to the`,'later;able � Yes No <br /> Tanks to be;riled hr. fate Arranged by Tete9hone <br /> f4ama <br /> 9. FILL-IJP <br /> Consider NO Lead. <br /> Extra product to"!op off”and run TSTT. How and who to provide 7 <br /> Teiminal or other contact - <br /> lot notice or inquiry' - Nam,s TYltpnonr <br /> company <br /> 10, CONTRACTOR, <br /> MECHANICS, -- - <br /> any.-:der contractor <br /> 11. OTHER <br /> INFORMATION -— ---OR REMARKS — <br /> µddi Tonal rnfofmstion on any items above.Officials or cthers io be advised when testing is. in prooress or completed.Vis.tors or observers present <br /> J..uing test stc. <br /> Tests were made on the above tank systems in accordance with test procedures prescribed for pP1r0 TIfP <br /> TEST K;LILTS as detailed on attached test charts with results as follows: <br /> w.::aao <br /> Leakage Indicated Date Tested <br /> rank Idenl�lication T'Cht !__- _ -- - <br /> '"`,is is to certify:sat these:ask syslerr:s were!e�sieci o :�9e date4sl shown.Those indicated as"Tight"meet the Criteria established y <br /> :he Nntiuntf otection Asocialion Pamphlet 3211. <br /> - __— - - __ .--.. - I >��.r_-„ -�_.._•�, I�, �i�; _- _ 4.r.�.-� !'am pan Hr S J-arul r, <br /> r�r't C'_•'� � <br /> ,.�'- 7 5,52 %'�r' ��r: .•�! •1,_..—__�� — _�_ <br />