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WORKSHEET FOR SUBMITTAL TO GOVERNMENTAL AGENCY <br /> OWNER/OPERATOR rl y Mi>v I 1444G SITE ADDRESS /736 <br /> CITY -c- COUNTY <br /> MAILING ADDRESS 5 <br /> SITE AGENT /U TELEPHONP Ckfj 7 2-2.6 <br /> ARRIVED UST SITRR LDCATIOM/NUBER �T,Ac �ROOUCT Ufa �7� do _� <br /> 4 <br /> DATE/TIME SU -f TRA® FILLS PRODUCT LEVEL AT ARRIVAL-INO@S BELOW 70P 0► FILL. NOMINAL TANK SIT <br /> TANK MAURIA= ��APPROX. AGft4e! -rRS. FILL SILK/TYPEOVERFILL CONTAINMENT <br /> /� o <br /> TYPE— <br /> AnGRAVITY I�/SG AT 4 7 DEG. F. • API GRAVITY 0 •L ON B 60► . COEFFICIENT OF EXPANSION OF: ^^^ lodASZ. COS OF-195- 7Z E ✓ <br /> VISARIE VENTING APPEARS TO ER AT: FILL END, ILL OPPOSITE EN HAS BURP TUBE, UNKNOWN, HAS A SALL CHECK, OWER <br /> VISABLE VAPOR TRAPS TO BE BLED: SALL CHECKS, MANWATS. OTHER <br /> RUSE It VAPOR RECOVERY SYSTEM TYPE: BALANCED AS 7�TO^R ASSISTED LONG RIM WELLS MANIFOLDED NONE OTHER <br /> PUMPING SYSTEM: SUCTION TDImI MAKE. )�� ? MODEL c PIPE LINE TEAR DETECTORS©?( <br /> CHARTED TANK SITEESTIMATED LIME QUANTITY_/ZP �P RDDUCT ADDED TO FLOOD SYSTEM�YSTEM GALLONS TOTAL <br /> AMBIENT WEATHER CONDITIONS: TEMPERATURE PRB7ES1=}iOST TEST�RAINING CLOT WIMDY IGHT OTHER <br /> SYSTEM FLOODEDI�V'145HOURS .6 PSI DROP_HOURS�PSI U BS MAINTAINED ON TANK BOTTOM DURING TEST PERIOD <br /> A. GRADE TO TANK BOTTOM �/�� <br /> Q 36 B. cum TO TANK TOP /��7Yz- <br /> C. TANK 01AWM INy� <br /> 67 p - D. TEST LEVEL ABOVE GRADE .. .. 36 <br /> E. ExrERNAL CRD WATER Agave TANK <br /> �„�/ ecrTaTT►, x .036I rst . <br /> EIY� P. TOP OP FILL TO PROD. AT ARRIVAL �� Jy�QQ// <br /> Al' G. TCP OF FILL TO TOP OF TANK ��5 <br /> 9 R 1�, H. TPS LSVEL'TD IOrrCN 01 TANK ALL <br /> C Y� PSI PER INCH OF PRODUCT •0�� <br /> WATER IN DB <br /> TNIK W _ TEST HEIGHT PRESSURE FORMULA <br /> E 119- <br /> H <br /> H. PSI PSI NET PSI <br /> REMARKS: <br /> `r <br /> THE FINAL TEST PERIOD AS SHOWN ON THE ATTACHED COMPUTER GENERATED DATA REFLECTS A <br /> COD)/ GAIN OF:-O�99 GALLONS PER HOUR, WITH A 99% CONFIDENCE LEVEL OF +/- , 0/3 GPH. <br /> USING THE HORNER EZY CHEK II METHOD OF TESTING THE RESULTS AS SHOWN ARE ITHI / <br /> NOT WITHIN THE STATE OF CALIFORNIA A 329 GUIDELINES 0 • KIMUM LOSS OR <br /> GAIN OF .05 GALLONS PER HOUR FOR TANK SYST TO BE CONSIDERED TIGHT <br /> INTEGRITY TANK TESTING SYSTEMS, INC. 166 FRANK WEST CR. <br /> STOCKTON, CA 95206 (209) 466-8036 or (800) 262-8378 <br /> CERTIFIED TESTERfva z✓ TEST DATEZIZ�Z AT Y <br /> , <br />