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WORKSHEET FOR SUBMITTAL TO GOVERNMENTAL AGENCY (TANK LAYOUT ON REVERSE SIDE) <br /> VEIIT:NG FY_ Tic DIP ?vmTa/T TLI:4 :AR% LDGAT:OL <br /> �1Gi�G <br /> LECAILI r=X l// <br /> PRODUCT <br /> �(.IYLO-.LG Q <br /> LIOU:D LR•L: Cd::ERAT:ORS AMBIENT TEMP. PRETEST TI POSTEST ¢� <br /> PLT:ES: POSIES: TO! OF r-*' TO ETY OF :ANL L I <br /> INKS S7�L 4'y �? WATER PRESENT PRETEST / YOSTEST�S`/`fi <br /> TOP OF !^..I. TO TOP 0! TAIM �- TiQG%�/-Z-,w <br /> or 2/0 24 /g'_ —_ :ml D.�.. -.� y3Yz INCHES ABOVE O� @ TEST START l J� <br /> nOSLMLH''P/ .iD - TEY.`LIATIILL ra•TRBAT:DRS <br /> AVEIAOL T10DDC. G1AV:TZ - i ! - <br /> T <br /> pliAL-::: ADDED LinnOPElSEl.: LIQLZD CONS:AK: (A) GOLFFICILI: OF L+'PASS:ON :AiI GA-'ACEI :ECPIIIi:IIBE CONS:AF: (E) <br /> Oly-30 TrV L r L rVEL GAIN+ TIMES V TEMP. TEMP. GAIN+ TIMES TEMP. FIRALTS <br /> . Try <br /> TIME C-ART END LOSS- CON_A 9�nStItT START END LOSS- CON B RESULT RESUL <br /> ,vo/ 'a794 -Z;?- 4)0-7i 4: PG 41 -.os4o5 -.aizg <br /> pyoo S7 1 6q 1 -�2--" I -,0 3k,64 22o 1 . 21Z-1-0J!� I I-• o�b5i �, aQOZ�z <br /> oyi� 164 0el76-¢ I . ziz 1 .�� I-,o�E I I-• ozyi�9 — o � �� %G <br /> —' o4z 2'a&' I .i9�' 1-vv7 Io34v oc7y5 -oSz' <br /> i4/ooa7i�o�� L 25 vIz_4 /9�+ I..i490 67 � <br /> 6-7 371IS'z+11--�0'665- 1II II---•.a'aOzZzgZZ- <br /> 43 2 <br /> -32 <br /> TEE 'FINAL-HOUR OF _ �¢� �y <br /> TESTINU P,EFLUTS A LOSSIGAlf OF : <br /> OWNEB/OPERATDR 7 _ <br /> SIIE ADDRESS GZ�c� (�'�1.(�•�/_, xi' <br /> MAILING ADDRESS " - USING THE HORNER KIT CHER METHOD OF PRECISION TESTING THE RESOL..S <br /> yam / / �- 7ATLDF-CA= 4 <br /> SEG8KL -AHD- THE-RFFA <br /> CITY �- 32o--G4TDL:TNLS--DP-'A-!llcRI ium 4'S t)Y'-�`r-6ALLON3--R.ER--ONL-H80R--OF <br /> CDIItiT7 -�.t«/'-- j!a-�.. - TSSI iiFr-FDP-mac-T2L8': "..17:/`�•='PM•." <br /> INTEGRITY INC. 166 FRANK WEST CIRCLE <br /> TELEPHONE (% _J - 7 - 7 "'G STOCKTON. CA- 952D6 (209y466-8036 (800) 262-8378 <br /> ; ;-i.:' ' ;�>,,. Y TEST DATE <br /> AGENT - CERTIFIED TESTER. , <br />