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> . � <br /> 6 ' Data Cha for Tank System Tightne6 Test <br /> 3 _9 - 193 petro Tatem <br /> PLEASE PRINT TANK TESTER 9. p7 <br /> 1. OWNER Property ❑ McCo_rmi_c & Baxter Creosot_in Coe _ <br /> g— -- {{ A}T4# <br /> Nqm Adtless Rnpreaentdtive V eprmn!'—"-- <br /> Tinkle) ❑ 1 14 w washi ton_ Stnclitnn Ca...._.g52.0 _-_.� �/��/�J(7a�p1�D.I(/y.1L(]�GES_ <br /> Name * Adores * Red,...nw ve "- Telephone <br /> 2. OPERATOR <br /> Nem. Address Telephone <br /> 3. REASON FOR <br /> TEST ral i fornia StatP T,aw -- — -- -- --- <br /> (Explain Fully) <br /> 4. WHO REQUESTED Ear y Shiba-------,, 3-18-87 <br /> TEST AND WHEN Name Tine Company or Atfillapon Dale <br /> - — - --- ------Addredressss--- Tel <br /> - - ----- - -— <br /> eph-on..e <br /> 5. WHO IS PAYING Same as-above <br /> FOR THIS TEST? Company.Agency.,Individual Person Authmiafno Tree Telephone <br /> Billing Access City Slate Lp <br /> � Anemion of: Older No. Other Inauuctiona <br /> Identify by Direction Capacity Brand/Supplier Grade Approx.Age Steelll'belglass <br /> 6. TANK(S) INVOLVED .3o12 4 _ TIN <br /> Location Cover Fills Vems Siphons Pumps <br /> 7. INSTALLATION See <br /> DATA RWW7-2 Earth 401 1211 None Suction <br /> G2H.uro <br /> Nonni inside ddyeway. Contest.Bleck Top. Size,Tnishil make.Drop Suction,Remote, <br /> Rear of slabon,etc. fan.etc. tubes,Remote Fills Size,Menilorded Which tanks? Make it known <br /> 8. UNDERGROUND / Is the Water over thetank? <br /> WATER Depth to the Water table _ _i_7Q_. —_ _ _." ❑ Yes 9—Ni <br /> Tanks to be filled-P..eyhe DatM/�TTrar(ged5>' .�AL.s�ts <br /> 9. FILL-UP Name Trillion... <br /> ARRANGEMENTS Extra product to'top off'and run TSTT. How and who to provide? Consider NO Lead. <br /> Terminal or other contact <br /> for notice or inquiry <br /> Company Name Til.phine <br /> 10. CONTRACTOR, -- <br /> MECHANICS. <br /> any other contractor <br /> involved -- -- -- <br /> 11. OTHER — <br /> INFORMATION ---- -- ----- ------ <br /> OR REMARKS _ <br /> Additional information on any nems above Officials or others to be advised when testing is in progress or completed.Visitors of observers present <br /> during test etc. <br /> Tests were made on the above tank systems in accordance with test procedures prescribed for PP1T0 T1�P <br /> 12. TEST RESULTS as detailed on attached test charts with results as follows: Iry <br /> Tank Identification Tight Leakage Indicated Date Tested <br /> Passed - - -- -- — <br /> Failed <br /> Cert. - - ---- <br /> Copy - <br /> Paid <br /> Charg <br /> Inv. <br /> County <br />