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{ 3s247 Rb.M6 SAN_-'JAN ENVIRONMENT J CO. <br /> IVANHOE,CA 93235'. PHONE(209) 798-1856 <br /> AINLAY TANK `TEGRITY TESTER" FIELD TEST DATA <br /> NAME ADDRESS PHONE <br /> i TANK 13-T0 - <br /> t <br /> OPERATOR <br /> s<< �� <br /> 2 IOENTI FI-FION CAPACITY—GALS. MANUFACTURER STEED FIBRGLS. AGE—YRS. <br /> ? TANKS TO O 1q -L- <br /> BE TESTED _ 3 <br /> 3 WATER <br /> DISTANCE FROM GRADE TO WATERI oZy INS. <br /> TABLE __ p <br /> 4 TANK WILL BE FILLED (TIME) ON -- <br /> TANK EXTRA 5 GALS PRODUCT AVAILABLE FROM 5 .1 �- <br /> FILL-UP FILLUPTO BEARRANGED BY Iy R. PHONE( I <br /> CONTACT AT STORAGE TERMIN4 IS MR. PHONE( I <br /> 5 NAME ADDRESS PHONE <br /> OUTSIDE — <br /> CONTRACTORS - <br /> 6 NAME AUTHORITY PHONE <br /> OFFICIALS <br /> i TO BE <br /> ! CONTACTED <br /> i <br /> 7 <br /> SPECIAL <br /> NOTES OR <br /> PRECAUTIONS <br /> 8 ALL TESTS WERE PERFORMED IN ACCORDANCE WITH PROCEDURES DESCRIBED IN SOILTEST'S <br /> INSTRUCTION BOOK. CRITERIA FOR TIGHTNESS IS ESTABLISHED BY NATIONAL FIRE PROTECTION <br /> ASSOCIATION BULLETIN. N.F.P.A.329. <br /> j TANK IS TANK IS LEAK RATE TEST DATE <br /> TEST TANK(DENT TIGHT NOT TIGHT G.P.H. <br /> RESULTS - ,57c - U I .00 3 — a <br /> SI Oma- 0� �� — . q .Z • q0 <br /> c 03 2_ <br /> '5 to G <br /> 9 THIS CERTIFIES THAT THE TANKS DESCRIBED WERE TESTED BY THE UNOERSIGNEO AND THAT THE STATED <br /> RESULTS REPRESENT THE TRUE STATE OF THE TANKS ON THIS DATE TO THE BEST OF MY KNOWLEDGE. <br /> CERTIFICATE NO. r I Z^ <br /> CERTIFICATION SIGNED �'" r(�+ ISSUE DATE <br /> y <br /> i FOR(TEST COMPANY) <br /> m <br /> F, ADDRESS <br /> m STATE ZIP <br /> r <br /> N <br />