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X3247 RL ss AN_ _- WAN NVIRONMEN_ TAL CO, <br /> IVANHOE. CA 93235: �. • PHONE (209) 798-1856 <br /> ' AINLAY TANK `TEGRITY TESTER" FIELD TEST DATA <br /> I 1 <br /> NAME� ADDRESS PHONE <br /> TANK Ir <br /> i OPERATORS O Ma r rwL�s <br /> 2 IDENTIFICATION CAPACITY-GALS. MANUFACTURER STEEL/FIBRGLS. AGE-YRS. <br /> TANKS TO <br /> BE TESTED St <br /> 3 <br /> WATER <br /> TABLE DISTANCE FROM GRADE TO WATER INS. <br /> 4 TANK WILL BE FILLED (TIME) ON <br /> TANK EXTRA 5 GALS PRODUCT AVAILABLE FROM �7( 4_ <br /> FILL-UP FILL UPTO REARRANGED BY I�R. PHONE( <br /> CONTACT AT STORAGE TERMINA"Ii.IS MR. PHONE( ) <br /> 5 NAME ADDRESS PHONE <br /> OUTSIDE <br /> CONTRACTORS r�Tr.r <br /> I 6 NAME AUTHORITY PHONE <br /> i <br /> OFFICIALS <br /> TO BE <br /> 11 CONTACTED <br /> i <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 /> f INSTRUCTION BOOK. CRITERIA FOR TIGHTNESS IS ESTABLISHED BY NATIONAL FIRE PROTECTION <br /> ASSOCIATION BULLETIN. N.F.P.A.329. <br /> 1 <br /> TANK(DENT TANK IS TANK IS LEAK RATE TEST DATE <br /> TEST TIGHT NOT TIGHT G.P.H. <br /> RESULTS � - p <br /> 1 <br /> i <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 /> CERTIFICATE NO. ��'- �•Z�,X�` <br /> m CERTIFICATION SIGNED -� `..I'.�'�.�. L1C.w' -- _.+-r% _ ISSUE DATE <br /> i w <br /> FOR (TEST COMPANY) +� ^ <br /> ADDRESS <br /> STATE _. . ZIP <br /> N <br />