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WORKSHEET FOR SUBMITTAL TO GOVERNMENTAL AGENCY (TANK LAYOUT ON REVERSE SIDE) <br /> VE•_'Na F/E Tic <br /> /IIEI: vIIY.F 5/. .ANT. LD"–'Or u <br /> ✓ GPRODUCT <br /> :ANS WAC= /00G>7/_i <br /> uoaxr Lrc^_ A:aaAT:oNs /�(� ANBIENT TEMP. PRETEST _� POSTEST <br /> PEE:ES: POSTES: To? OF T= TO ZTE or TAYL T= <br /> p7 WATER PRESENT PRETEST /� POSTEST <br /> ZxwLf <br /> /94/ /�z — To? OF r= To Tor or TAPE -S <br /> Or t� vsz -- zAwE DZAlffTEE `-/c— IN CESS ABOVE GRADE @ TEST START 2/ it <br /> . <br /> 11oVLlSLwT 1 _ — — - _E!^EEATOLF G:.xsEA-Tows <br /> ASEEAeE � A.P.x. raonaC: cE►v�= 4Lt <br /> z <br /> COEFF:CIEr: OF FSPAHS.OA :AW: CA--&C-.TTEEPELATUEI CORS.AN. (3) <br /> QOAr::—. ADDED L:RL EOVEHEI'2 ' LIQVID CONSTAK: (A) - <br /> 1 FIRILL <br /> iL7 LT VEL LEVEL GAIN+ TIMES T,r�Vrl, TEMP. TEMP. GAIN+ TIMES TEMP. <br /> TIME SART END LOSS— CON A KaSDLT START END LOSS— CON B RESULT <br /> RESULTS <br /> i.314? 1 /e_ I'-i6 I <br /> ( iJ72— i — 14 14 �9 1. �9 24<3z <br /> 1 - ; - 1-.avG i ==y/� azo <br /> i; 113 , I — <br /> 4? 2 I -,cl2yrf <br /> 14ze //.o�Zy I i/ I '—i9 I I a � a� , I .oy7 I-.C761[14sl <br /> 3_5 //0 14 <br /> .z_ a?z I. t'1�� Ut1 c I 1 -,�zyi�r <br /> /4.50 .f z�y� <br /> _.-- <br /> THE 'F?NAL"fiDIIR OF r— �% L7.e6 �9 <br /> TES°"TZ.0 REF::Er uOSS GL=1C OF: <br /> OWNER/OPERATOR <br /> SITE ADDRESS -�(~c-%--% G'✓ `�•""'Ll'1�.; '— G C _ <br /> MAILING ADDRESS USING THE B PSR-St4-�1THOD OF PRECISION CALIFORNIATESTING THE RESULTS <br /> CITY —� /�., �� <br /> ARE WS7ESr � RE GDT F.+ESr RE SZAZE OF GALLONS <br /> AND THE AFPA <br /> / 329 GUIDELINE SS OF .05 GALLONS PER ONE HOUR OF <br /> TESTING FOR A -ILEI ?A—fCOUNTY -7 • <br /> 10 INTEGRITY TANK TESTING SYSZEY.S. INC. 166 FRANK WEST CIRCLE <br /> TELEPHONE (�G'f 3-34 ' 7/ Zc� STOCKTON. CA. 95206 (209 466-8036 (800) 262-8378 / <br /> AGENT C,iL <br /> CERTIFIED :ESTER. <br /> /��� -'C�?`r-'✓� TEST DATE !/l� <br />