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X8247 Rb.m6- AN- WAN ENVIRONMENTAL O, <br /> IVAWOE, CA 93735'. i. PHONE (209) 798-1856 <br /> i, <br /> AIN LAY TANK `TEGRITY TESTERT" FIELD TEST DATA <br /> ! 1 NAME ADDRESS PHONE <br /> TANK !S�\o <br /> OPERATOR '- <br /> ISz��--- <br /> 2 IDENTIFICATION CAPACITY—GALS. MANUFACTURER STEELIFIBRGLS. AGE—YRS. ! <br /> TANKS TO <br /> BE TESTED <br /> 3 WATER <br /> TABLE DISTANCE FROM GRADE TO WATER INS. <br /> 4 TANK WILL BE FILLED _9", (TIME) ON <br /> TANK EXTRA 5 GALS PRODUCT AVAILABLE FROM <br /> FILL-UP FILL UP TO BE ARRANGED BY 10R. PHONE( <br /> CONTACT AT STORAGE TERMIN.d-IS MR. PHONE( ) <br /> i <br /> 5 NAME ADDRESS PHONE <br /> OUTSIDE _ <br /> CONTRACTORS �`✓��- <br /> i 6 NAME AUTHORITY PHONE <br /> OFFICIALS <br /> TO BE <br /> CONTACTED <br /> 7 <br /> i <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 /> I ASSOCIATION BULLETIN. N.F.P.A. 329. <br /> ! TANK IS TANK IS LEAK RATE <br /> TEST TANK IDENT T GHT NOT TIGHT TEST DATE <br /> RESULTS J _ -u'a1� <br /> - 9 THIS CERTIFIES THAT THE TANKS DESCRIBED WERE TESTED BY THE UNDERSIGNED AND THAT THE STATED <br /> RESULTS REPRESENT THE TRUE STATE OF THE TANKS ON THIS DATE TO THE BEST OF MY KNOWLEDGE- <br /> sir CERTIFICATE NO. Sn '�Z-°` 1 <br /> CERTIFICATION SIGNED <br /> LIC• ISSUE DATE <br /> " W <br /> Q <br /> FOR (TEST COMPANY) <br /> ADDRESS <br /> STATE ZIP <br /> Y <br /> N <br />