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DA`TA f TART FOR TANK .SYSTEM TIGHTNESS TEST <br /> {EKY CHEq - <br /> :. CRISP TUK TESTS I <br /> P.MAY 2 s 1994 STOtK�OH�CA49� _ <br /> (204)431-IRS a <br /> C10910NMENIAL HEALTH - <br /> ��. . p1nl IEIR QR-REALE __ °�f' r \( �' DATE OF TEST ME ;��(� TIME c=WISH.- j ' LENGTH CF TEST , .< <br /> ADDRESS (NO. & STREET) _� [� 7 i&) t'Ir,---A-y ',,-- - WEATHER TEMPERATURE <br /> CITY AND STATE <br /> •TANK INFORMATION �- <br /> OL90.__ — c i _ IN. CONTENTS (PRODUCT) <br /> CAPACITY (NOMINAL, GALS. S;Z_ OF FILL OR TEST OPENING <br /> 4�dUR DAT=_ 5 E l � � TANK MATEr�1•IAL METAL(Y) �IgCau�ASS( <br /> CAPACITY (CHART) GALS. TOP OFF TIME --- .� �� -- GALLONS <br /> DIMENSIONS. DIAMETER NUMBER OF GALLONS ADDED TO START TEST C): APPROX. AGE ` <br /> LENGTH TANK NO. -� PUMP SYSTEM TYPE SUBV-) MAS` <br /> INCHES OF WATER -- BEFORE TWS T e%FT;.R TET ' LE.AK. <br /> TEST _ L�PrK" -DETECTOR YES NO 4 ) , <br /> TEST CALIBRATION t , VAPOR RECOVERY SYSTEM �S ) <br /> TAMC LAYOUT E Y_ NO ; <br /> �� OF 1L. BAR Or, M?'S ADDED < � 5 — t t <br /> S;�: - <br /> LINE MO. ;RENT <br /> 3 ,a to c j — LINES <br /> 2 ' �: — - ' INE., <br /> s to �'' -- a LIN=S I <br /> TOTAL LINES - 3 LINES <br /> (ALM) I <br /> - I <br /> END OF TEST CALIBRATION . I <br /> SIZ= OF CAL. BAn OR MLS ADiD=D v <br /> (ALM) (Fk+ -,VF,A) I � <br /> LINE MOVEMENT <br /> V-5 tc i° _ — LIN=q <br /> 2 i ` to F� — LINES <br /> to ` k LI NES <br /> vT►=L LIN:S <br /> (ALM) } <br /> MEASURED API SPECIFIC GRAVI:v f # <br /> PRODUCT TEMPERATURE ' =a <br /> API SPECIFIC GRAVITY C Ss?° F 7 '» _ — --- (FROM 3r;.°LE A) <br /> COEFFICIENT OF EXPANSION .,, _ ), 1_` .s ___—.- (FROM TABLE S) <br /> 0 0 6 )_q3. x 0 "o (FAC OR B) <br /> p E TOTAL CAPACTY (GAL) VOL CHANGE*F <br /> OWNER OF-SITE ADDRESS <br /> CITY STATE ZIP CODE <br /> OWNER OF TANK ADDRESS <br /> CITY STATE ZIP CODE <br /> . COUNTY _. <br /> TECHNICIAN(53 DATE <br />