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Data Chart for Tank System Tightnesu Test <br /> petro Tite <br /> PLEASE PRINT TANK TESTER <br /> I <br /> 1. OWNER Propany, �] FEt7/uD Sio 7ov C7f,> /boy w.r✓IA/rJs'r. S7-vLk7vnl CAL. <br /> wm. <br /> Taap) C--Add. SQENT60 R 209 'moo S'zaF(p 3 <br /> Mpw Addran RpNaenugw TaNpMna <br /> 2. OPERATOR <br /> No. Address rx.pnon. <br /> I <br /> 3. REASON FOR Akwu Ac. _Dv.9hfid,X.E vwrT-I CA(. rFO RNI✓+ tiN D,-9r1R41A0.1 D -M"K <br /> TEST <br /> I Esplain Fully) <br /> 4. WHO REQUESTED --------------- — <br /> Tina ComwnrSit wnuurron ox <br /> TEST AND WHEN N" e <br /> Address lxaononf <br /> I <br /> 5. WHO IS PAYING --- - ------ —— -- <br /> - Cxewny—Agency or lndie<wl Penon AutMnti p <br /> FOR THIS TESTI qe TNapnow <br /> mitre Asorws _ —_-- GrT sul'� <br /> AtNmwn ol: dire.Na. OdNr InxmOiont <br /> Identity by Direction capacity Brand/suppller Glade Appro..Age Stele/Fibeaglass <br /> 6. TANK(S) INVOLVED NDRT`I /00D3 a4lAc' 30 V/L5 <br /> Location /J.EXTID Corer Fills vents Siphoned Pumps <br /> 7. INSTALLATION �! 00"EC <br /> DATArIfI d �.1 I1 07.fF Sr.(G 77O IJ <br /> lNy <br /> North MNW drive..'. fboeuN.abck Too. Size.TOWN make.Drop Sueuon.axnate. <br /> -.A.of unkso.etc. Eenn.etc tuber Renrew Fred Sue.MaNIONM wllldr Ynkf t make n kMwn <br /> S. UNDERGROUND �O IS the water over this unkT <br /> WATER Depth to th,Water table 0 Y. 0 No , <br /> Tanks to be filled h <br /> t. Data Arranged by <br /> 9. FILL•UP _ - N.M. iN.pnpn. <br /> ARRANGEMENTS Este Product to-top oil-and run TSTT. Now and who b provide? Consider NO Load. <br /> TermMN dr other contact S� <br /> for notice or inquiry, <br /> it <br /> Comp.M, Name TNepnona <br /> 10. CONTRACTOR, <br /> MECHANICS, <br /> j any ether comractor <br /> imrolred _. <br /> 11. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> Adilmorul inlormatwn on any Tums above.011icialf or*the,.to M advised wMn teitinq it in progress or complebd.Visitors or obwrvara present <br /> during lost etc. <br /> Tests saws made M the above tank systems In accordance with lost procedures preecribed far OL•h0 TIt! <br /> 12. TEST RESULTS as derailed an attacgsd test charts with results as follows: '�—ItiID _ <br /> TankI antificstwn Tight Leakage Indicated Data Tested <br /> U <br /> This Is to certify that these tank systems were tested an the date($)shown.Those Indicated as" qh ' eat the is established by <br /> 13. CERTIFICATION the flatland$FireProterc tion Asociatlon Pamphlet 329. <br /> r r r err _ 7hi/ID¢,Co�CLi SR, l.ErJ.EAy. cTxs. <br /> ' D N ienmp Comocur a COmwM. er: ignxwe <br /> yCj -�o.3x� a3�gT,-rroul Cr�L 44SQi <br />