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14m. <br /> WORKSHEET FOR SUBMITTAL TO GOVERNMENTAL AGENCY <br /> OWNER/OPERATOR �iQ�.��q ' ��. Fid Q,QIS S SITE ADDRESS <br /> ctn_ ///A��T�ZA 9S3�G couNtT---�J/yCJ 0�4ti>r>liC1 <br /> MAILING ADDRESS <br /> SITE AGENT TELEPHONE eb <br /> ARRIVED TEST SItF� OMIRg TANK LOCATION // �� <br /> 0" <br /> 6 PRODUCT / <br /> DATE/TIME STORAGE TILL►O�/r. PRODUCT LEVEL AS ARRIVAL�INCHES BELOW TTOOPP OF FILL ZNOMINAL TANK St2E s fl <br /> TANK MATERIAL .�(.e[i(� ArPROK. TANK AGE7f TRS. Ftt.LSIZE/TTPE T OVERFILL CURTALHMP.NE ITPE n <br /> Mt GRAVITT�4 AT -a oEG. F. - Art GRAVITY Or .-3 Z 8 6OF - COEFFICIENT OF EKPMStON OF .000 4-5-19-5- - COE 7 <br /> VISMLE VENCIRG APPREARS TO BE AT, FILL END, LL OPOSITE <br /> HAS DURF 7tM0E, RM BALL CHECK. UNKNOWN, OTHER <br /> VISMLE "FOR TRAPS TO BE BLED: BALL CHECKS, HANWAYS. •LIMES. OTHER <br /> PHASE II VAPOR RECOVERY SYSTEH, BALANCED. ASPIRATOR ASSISTED, LANG RUN .TELLS. NANTFOLDED,� DINER <br /> PUIV INC SYS E(IC``IION TURBINE MMP/ AMY 7-,vN/L. YODEL PIPE LINE LBM Detectors YtS, No; NOT ArtLIC <br /> CHARTED SIZE 3d� EST. LINE QUANTITY S PRODUCT ADDED To FLOOD SYSTEM S "- STEM TONAL GALLONAGE s60 <br /> ANNIE" CONDITIONS: TEMPI FRETESY7Y VOSTES 'U� CLOUDY, RAINING. WINDf <br /> EF <br /> `T'� r NIGHT, OTHER <br /> .4 PSI DROP DUDES TEST TO START ROM PSI TO BE MAINTAINED ON TANK BOTTOM DURING TEST PERIOD <br /> 4rO rot <br /> A. CRAMP. TO TANK NOTION <br /> air B. MADE TO TANK TDP �7r� <br /> 6.lApE C. TANK IMAWRTER 4 <br /> n--~ D. FAST LEVEL ABOVE MDR a.5 <br /> • �� B�� t. 240MAL Cb NATER AsOVt TANK <br /> smam— IN. K .0761 PSI <br /> TDP OF FILL To FOOD. AT ARRIVAL 7 <br /> A/03 O. TOP OF FILL TO TOP OF TARR / / <br /> C ¢� N. 7047"LSYR'lO lOrTo1 OR TIWR p� <br /> w�( RATER LN DR P31 PER INLTI OF ►b011Ct /`�' / <br /> 1 TANK <br /> E1 � 123t IRifM PRESSURE FOEKILA <br /> REMARKS- H. tsL 7AI NEr rs <br /> RESULTS <br /> TIME FINAL TEST PERIOD AS SHOWN ON THE ATTACHED COMPUTER GENERATED DATA REFLF.C'PS A <br /> OS / GAIN OF: %L01�- GALLONS PER FLOUR, WITH A 99% CONFIDENCE LEVEL OF +/— _4!25�0 gph. <br /> THE HORNER EZY CHER II TEST METHOD COMPLIES WITH EPA AND THE STATE OF CALIFORNIA PERFORMANCE STANDARD OF 0.05 CPN <br /> FOR TANK INTEGRITY-TESTING. (SECTION 2643 CALIFORNIA CODE OF REGULATIONS) BASED UPON THIS STANDARD, THE RESULTS <br /> SHOWN ABOVEOW DOES NOT INDICATE AN UNAUTHORIZED RELEASE EQUAL TO OR GREATER THAN THE 0.05 GPM STANDARD. <br /> INTEGRITY TANK TEST/II``N/j �R/VICES, 166 FRANK WEST CIRCLE, STOCKTON, CA., 952206, (209) 466-8036 or y(80 ) 262-8378 <br /> CERTIFIED TESTER N/ gOa4e, STATE LICENSE 1 G0'��V TEST DATE <br />