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WORKSHEET FOR SUBMITTAL TO GOVERNMENTAL AGENCY <br />UWNER/OFERATOR/�"lC�y CriiE l'R%`�C�C� 1001,ykw SITE ADDRESS <br />C!_ <br />CITY�i� �-� COUNTY <br />HAILING ADDRESS <br />SITE AGM /69Al- -) TELEPHONE %Z1_ �c7 4 � 7-6 <br />ARRTVED TEST SITV71''aOURS TANK LOCATION <br />DATE/TM STORAGE FILLED. CJ RODUCT LEVEL ATT� <br />ARRIVALINCHES BrLOW TOP OF FILL RMIRAL TANK SIZt <br />TANK HATERIAL AFFRoA. TANK A96 -TRS. FILLSI7.E/7TPE__41 OVERFILL CONTAINMENT TTPF <br />AFI GRAVITY �rSAT 6U DEC. F. - AFI GRAVITY oq� @ 60F i COEFFICIENT OF ERPANSION OF ,OOb ,/rf - COE fi/, 7 , <br />VISABLE VENTING APFREARS TO BE AT: FILL END, FILL OPOSITE END, NAS SURF TUBE, RAS BALL CHECK, UNKNOWN, OTRFR <br />VISAHLE VAPOR TRAPS TO BE BLED: BALL CHECKS, HANWATS, RETURN LINES, OTHER <br />PARSE It VAPOR RECOVERY STSTEH, BALANCED, 1j,�AS7�PIRATOR ASSISTED, Rqii VN WELLS, HANIFOLDED, NONE, OTHER <br />FUIiFING STSTEH: SUCTION, INE HAKE 441 Il Y� CS MODEL PIPE LINE LMX DeteCtai TAS NO; NOT�aAFPLIC <br />CHARTED SIZE 515-6 EST. LINE QUANTITT20 PRODUCT ADDED TO FLOOD STSTEH 46 STSTEH TORAL GALLONAGE <br />AMBIENT GONDIITIONS: 712W: PRETEST�kzPOSTEST � RAINING, WINDY, EEZT, IGRT, OTHER <br />.4 PSI DROP{ eOpOURS TEST TO START./, OURS PSI TO 19E HAINTAINED ON TANK BOTTMI DURING TEST PERIOD ' PSI <br />A. CRAM TO TANK lOT1DH 14 <br />Q b. MAN TO TANK TOP sl/ <br />6�PiT A£ <br />7' <br />C. TANK DIAMETER <br />D. TEST LEVEL ABOVE GRADE <br />�f C4: <br />-3-0 <br />E. EATEMAL CPO[IND MATER ABOVE TANK <br />1funmi TM. K .0361 PSI <br />F. TOP OF FILL TO PKOO. AT ARRIVAL - <br />6. TOP OF FILL TO TOP OF TANK <br />H. TLn:axVEL'TO !077TH OR TANKS, <br />PSI PER 11101 OF PRODUCT,--rL <br />I TANK •f n %' TEST HEIG" PRESSURE FOVULA <br />4-54 <br />P E PSI NET PSI <br />REMARKS: <br />RESULTS <br />HE FINAL TEST PERIOD AS SHOWN ON THE ATTACHED COMPUTER GENERATED DATA REFLECTS A <br />OS I GAIN OF:, 40,�?G-ALLONS PER HOUR, WTTll A 99% CONFIDENCE LEVEL OF +/- . OQ/ aph. <br />THE HORNER EZY CH EK II- OD COMPLIES WITH EPA AND THE STATE OF CALIFORNIA PERFORMANCE STANDARD OF 0.05 GPH <br />FOR TANK INTEL I ING. ( C77TTION 2643 CALIFORNIA CODE OF REGULATIONS) BASED UPON THIS STANDARD, THE RESULTS <br />SHOWN ABOVE: DOES NOT NDICATE AN UNAUTHORIZED RELEASE EQUAL TO OR GREATER THAN THE 0.05 GPH STANDARD. <br />INTEGRITY TANK TEST S RVICES, 41 WEST YOKUTS ST. STOCKTON, CA., 5207,, (209) 474-1375 or (800) 262 8378 <br />CERTIFIED TESTER STATE LICENSE Pif <br />I V �� TEST DATE f� <br />