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' Executive Order G-70-164 Report No.: <br /> • Distribution: <br /> FORM 3-1 Teat Dalt: <br /> Teat Times- <br /> Run A: <br /> Summary of Run B: <br /> Source Test Results Run C: <br /> Source Information Facility Parameters <br /> GDF Name and Address GDF Representative and Title PHASE Il EQUIPMENT <br /> System: <br /> NOZZLE Type/Number <br /> GDF Phone No.( ) <br /> Source:GDF Vapor Recovery System Comments <br /> Permit Conditions GDF At <br /> A/C# Manifolded? Y or N <br /> Operating Parameters: <br /> Number of Nozzles Served by Tank 41 Number of Nozzles Served by Tank#3 <br /> mber of Nozzles Served by Tank#2 Total Number of Gas Nozzles at Facilty <br /> Applicable Regualtions: FOR OFFICE use oms: <br /> Source Test Results and Comments: <br /> TANK#: 1 2 3 TOTAL <br /> I. Product Grade <br /> 2. Actual Tank Capacity,gallons <br /> 3. Gasoline Volume,Gallons <br /> 4. Ullage,gallons(92 43) <br /> 5. Phase I System Type <br /> 6. Initial Test Pressure, Inches H2O(2.0) <br /> 7. Pressure After I Minute,Inches H2O <br /> 8. Pressure After 2 Minutes, Inches H2O <br /> 9. Pressure After 3 Minutes, Inches H2O <br /> 10. Pressure After 4 Minutes,Inches H2O <br /> 11. Final Pressure After 5 Minutes,Inches H2O <br /> 12. Allowable Final Pressure from Table 30-1 <br /> 13. Test Status [Pass or Fail] <br /> i Conducted by: Test Company Date and Time of Test: <br /> Name <br /> Address <br /> City <br />