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KeeziVeJ- <br /> WORKSHEET FOR SUBMITTAL TO GOVERNl1EN'FAL AGENCY <br /> ounra/orERAloa /Ty O� S%� � aliF. AnnPESS 470/ <br /> CITYFiy ,A�3op+� <br /> HAILING ADDRESS / AoW 4- 4,3 <br /> SITE ACT.m _•/E.e.¢y TES TELErn011E (Zff) <br /> ARAIVED TEST 6[?Q7�ROlIRS /TAANTANK: 11 LOCATI0 �I/j� sT�9T/L7�J 7RODOCT <br /> OA7F,/i DST. RTDRAGC EILLED/ 4'pp &IERODUCT I.COCL IVAITRS�IS ILC/77rE�� OV FJIFTor or ILL COPTAIRILIIT TTF F.�a�_ <br /> LANK MATFRIAL O1i�C� ArrROI. TANK All/454 p �1 c <br /> Arl GRAVITY 33 AT Td Orr- T. - Ari GRAVITY Orn•/ ! 60F - COFETICTC/R OF QrANSION OF .000 7Sp Z3 - cnr _Qs? <br /> VISAALE V17MINC ArrRFARS TO BE AT, ETLL Effit. FITT, OrOSITE "m' lal PURr rvmi OAS SALL CHEM. I7TIK11DW11, OLTI" <br /> VISAALE VArOR TPArS TO BE ELM: BALL CIFCK.S, HARWAYS, RETURN LINES. OTRKR <br /> rRASE II vAmR RFCOvtRT BTSTEyI, SAI.ANCED. ASrwrm Assisim, LONC RUN WELLS, MANIFOLDM. 5IF OrntR _ <br /> r VIO'TNC STSIT111 VCI70n TWIATNE MAGP, 41/= 9iQyQ,Gd "Mm (f'0ej=rirt LIRE LWC Detectors TF.S, No; OTCAfr Lt <br /> CTIARTFn SiKE -1'50 FIT. LINE OUANTITT A rROOUCT ADDED TO FLOOD STSIEM 3 SYSTEM TORAL CALLONACE <br /> AI0l I MIT COTMITIONSI YETIT, rRETtSY��rjjO S�ATtSi SVIIN CLmml- RAIN/11C. WINIT, BRtF-", RICRT. OTTIER " <br /> .A ESI DR1049ROURS TEST TO STAA1145 Timm PSt TO BE HAINTAINl1T On TANK BOTTOM DURIRC TEST VERIOO 313 es <br /> _ A. r.RAM. To TATs[ ROTM4 C7/ <br /> OR. O1lAI@ TO TANK TOP G�z <br /> C. TANK RIAVTRER <br /> 6 G1 0! A <br /> D. TEST I.BM.L AWT! QMD! L7` <br /> i� <br /> • •1 �y�e'-- !. <br /> SI' CnIHD A1TNI <br /> eor7cti l". I .01 <br /> 6I <br /> nt <br /> �Iy N E. Tor Or FILL To FOOD. AT ARRIVAL <br /> 1/ 0. TOP OF FILL TO TVP Or TAnt 32 <br /> y, N. ymS lATR'TO KD"m OF TANTT /OS <br /> Ie <br /> RATER IN C r5i req Incur of FIomicr <br /> TEST REMIT PR23SUKt FORICLA <br /> _ /05 K 03/ 3•ZS <br /> ,1, r31 - 1 MFT <br /> REMARKS! <br /> RESULTS <br /> 'CITE F_WI, TEST PERIOD AS SHOWN ON 111E ATTACHED COMPUIER GENERATED DATA REELGC'I'S A <br /> LOSS / ;l'AIy OF: 4.6tZGALLONS PER HOUR, WITH A 99% CONFIDENCE LEVEL OF gpll. <br /> IIIE HORNF.R EEZY CHEF. IT TEST METHOD COIfrLIFs WITII ETA AND INE STATE OF CALIFORNIA PERFORMANCE STANDARD OF 0.05 GFN <br /> FOR TANK INTEL I7 -E. ECTION 2613 CALIFORNIA CODE OF REGULATIONS) BASED UPON THIS STANDARD, TOE RESULTS <br /> SHOWN ABOVE? ES NOT INDICATE AN UNAUTHORIZED RELEASE EQUAL TO OR GREATER THAN TRE 0.05 GFH STANDARD. <br /> INTEGRITY TANK TEST�ING� Y,TRVICF.S, 166 FRANK WEST CIRCLE, STOCKTON, CA., 95206, (209) <br /> (209) 666-8036 or (800) 262-8378 <br /> CERTIFIED TESTER II )T[FAM/N{'/V STATE LICENSE / 90� lo l/✓ TEST DATE <br />