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WORKSHEET FOR SUBMITTAL TO GOVERNMENTAL AGENCY (TANK LAYOUT ON REVERSE SIDE) <br /> VEN::FL F/T_ F/C DI}: PDHF/SRF ALF '0'11"01: Ile <br /> EEMAR'sS V <br /> TANF. CLPACIS' nn PRODUCT , <br /> LIODID LEVEL CAL:ERAT:ONS <br /> rjur:ES: POSIES: :OF OF FILL TO ETn O7 :ANE WL-ER PRESEE- PRE:ES _POSTES: -& - <br /> LINES ;J/ �— — TOP OF FILL TO TOP 07 TAHL INCHES ALOVE GRADE 7 :EST STAIT1? <br /> y� yy <br /> 07 �� :LHR alan:ru <br /> novEMEeri TEMPERATURE ce:.IaRa�:ons <br /> AVERAGE J L.P.I. PRODUCT CYAVITT"331y fONAVISS 07 ���Pb07 <br /> f0 a s Lis n cC) 5�yS90 E / i 3SA <br /> R/ }/ QUAL: ADDED LIFE MOVEMENT LIQLID CONS:AN: (A) COEFFICIES: OF EIPLNS:OF TAKE CIPACI T •:EnPERLIDRE CONSIGN: (S) <br /> LrVEL LEVEL GAIN+ TIMES LrPc, TEMP. TEMP. GAIB+ TIMES TEMP . FIfiAi <br /> TIME S =ART END LOSS— CON A tsrt T START END LOSS— CON B .= RESULT RESULTS <br /> 4F3a 1 I I ' o 'oo 1, 7 16' ' �o /6 ` <br /> 57S 7511 . I� I I% o, 0 3 <br /> I 'aoS 1 , 1"-66.z 1 2-40 16 7t S <br /> is I <br /> SY 1 '5' ,5 ',S 1 1 'o t I .n 9I o01 i `o167 a8S2 , <br /> goo I Sa•,SI I I I' 7 I <br /> 9y I I '/ I I 'oo .?S ?I 777 F <br /> 1 /0` i 1 . 1 — o . .7 77 I 771 <br /> 6 3 1 ,7771 . 7 71 -et- I <br /> THE -FINAL <br /> //n 0 TESTING REFZELTS A LOSY19AIN PF : �Od �D 's <br /> OWNER/OPERATOR <br /> sJ���YL <br /> SITE ADDRESS `1OOZ'� w I�LCi' ✓C-Z <br /> MAILING ADDRE S US ORNER EIT CHER METHOD OF PRECISION TESTING THE RESULTS <br /> CI-v �t lam- SE W.-PT' i ARE NO' WITEIF THE STATE OF CALIFORNIA AND TEE NF-A <br /> ` ., vu IDELINES OF A MAF-IMUM LOSS OF .05 GALLONS PER ONE HOUR OF <br /> TESTING FOR A TIGHT CANE1S?STEP- <br /> COUNT7 <br /> TELEPHONE ( ) / INTEGRITY TANK TESTING SYSTEMS INC 166 FRANK, WEST CIRCLE <br /> STOCKTON. CA. 95206 X209) 4 '- 03 (800) 262-8378 <br /> AGENT ` 'C TEST DATE_������ <br /> CERTIFIED iESIER <br />