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Data Chart for Tank System Tightness Test_ <br /> petro TitP <br /> TANK TESTER <br /> PLEASE PRINT <br /> 1. OWNER Property C,�'ew <br /> ® Name AOeuf ReprOenOlive Tebpnonr <br /> Tanks) f. <br /> Nome Addnu R......nutW. - rale,"one <br /> 2. OPERATOR Name Address r.l.0nen. <br /> 3. REASON FOR <br /> TEST <br /> I Explain Fully) . <br /> 4. WHO REQUESTED <br /> TEST AND WHEN Nem• rill. Company or Affiliation D.T. <br /> Addless T.I.D"on. <br /> S. WHO IS PAYING CemDany.AO•nCY OI lndlvldual P.reOn AutnOrltlnp n. T.l.Ohon. <br /> FOR THIS TESTI <br /> Illlllno Address city Sou 21p <br /> Attention of: Order No. Other I.,ouctlona ' <br /> Identify by Direction Capacity Brand/Soppliar Grade Approx.Ape Steel/Fiberglass <br /> 6, TANK(S) INVOLVED u' J! D <br /> Location Cover Fills Vents Siphones Pumps <br /> 7. INSTALLATION <br /> DATA e�f Cott h2111Q)' •C �I " i= %'2 v'C '�✓2 <br /> Norm Inside dtivewaY, Conaere.Black roti. Site. <br /> TIu1111 Drop so to <br /> -R.most- <br /> Rasr OI 11.1 etc. Enlh,ere. tuba.Rama.Fills Sia.M.M olded wMcn tantaJ Mao d known <br /> 6. UNDERGROUND Is m.water over me tepk v <br /> WATER Depth to the Water table t(�/ ' �}-M A_T Yes No <br /> Tank.to be filled�L hr. 77 Data Arranged by <br /> 9. PILE-UP N.m. rete°"°^• <br /> ARRANGEMENTS Extra product to"top off"and run TSTT. How and who to provide 7 Consider NO Lead. <br /> 4+ <br /> Terminal or other contact <br /> for notice or inquiry <br /> Company Nam. Telephone <br /> 10. CONTRACTOR, <br /> MECHANICS, <br /> any of contractor <br /> involved <br /> 11. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> Additional information on any Rome above.011icials or others to be advised when testing is in progress or completed.Visitors or observers present <br /> during teat erd. <br /> Tests were made on the above tank systems In accordance with teal procedures prescribed for Pp}rO TI}P <br /> 12. TEST RESULTS as detailed on attached tact charts with results as follows: .r—r dSria— <br /> Tank Identification yTight j Leakage Indicated Date Tasted <br /> 13. CERTIFICATION This is to certity that these tank systema were tested on the date(s)shown.Those indicated as"Tight"moat the criteria eatabiished by <br /> the National Fire protection Asoclation Pamphlet 029. <br /> Lawrence Tank. Testing <br /> D.+. P.O. Box 407 <br /> av: la tor. <br /> 5enatNo.aThermal Technl.,.ns Downieville,California9593b (916) 289-3109 <br /> swa <br />