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WORKSHEET FOR SUBMITTAL TO GOVERNMENTAL AGENCY <br /> / <br /> OWNER/OPERATOR !!AZA SITE ADDRESS /7f� N I(dILSo.0 jb,4)/ <br /> CITY COUNTY Z47 �Sr91�Ul� <br /> MAILING ADDRESS 9 IDS <br /> SITE AGENT -a`olrOeJ A64-zfDti TELEPHONE — 2L <br /> ARRIVED TEST SITEZ59 MURS TANK LOCA�/T7fION/HUMBOR <br /> DATE/TIME STORAGE FILLEP�'e00VCf LEVEL(ATATT AARRIVAIlL MCNES BELOW TOP OF FILL. NOMINAL TANK BIZ/B /OO OU <br /> TANK MATERIAL G�APPROX. AGRele Yls. PILL EIZIMFI� VERFTLL CONTAINMENT TYPE '••���// <br /> API GL �/Y� <br /> RAYITT_ ATDEG. F. • API GRAVITY OP5�B GOP • COEFFICIENT OF EXPANSION OF: NDD G/UGi S• COE OF3(L <br /> VISABLE VENTING APPEARS TO BE AT: FILL END, <ETL OPPOSITE E HAS BURP TUBE, UNKNOWN, HAS A MALL CHECK, OTHER <br /> VISABLE VAPOR TRAPS TO BE BLED: BALL CHECKS, MANWAYS, OTHER iVO.[�E' <br /> RUSE II VAPOR RECOVERY SYSTEM TYP BALANCE ASP A R ASSISTED LONG RIR! WELLS MANIFOLDBD NONE OHIEA <br /> PUMPING SYSTEM: S �TI TUPD IN _ MODELODPL PIPE LIMB IEAK DC1EC10PS�H <br /> CHARTED TANK SIZE[��w_( pp4STIMATED LINO QUANTITY /9� PRODUCT ADDED TO FLOOD SYSTEM_L_SYSTEM GALLONS TOTAL <br /> AMBIENT WEATIIERCOQNND/IIT�T�IIO,NS: TEMPERATURE PRETBSisZPCST TEST MMIND RAINING CLOIDT NIGHT OTHER <br /> SYSTEM FLOODPD4/1��NOHO1RS .A PSI DROP Hours PSI It BE MAINTATNED ON TANK BOTTOM DURING TEST PBRIOD <br /> A. GRAIN! TO TANK BOTTOM <br /> . Q 9 GRAIN!GRATO TANK TOP <br /> C. TANK DIAyETER 9�%4 <br /> 6 G1 DE <br /> D. TEST LHVEL ABOVE GRAM .. . �• <br /> 3, <br /> F— ABOVE <br /> G F— e. EXTERNAL GROUND MIN. X .0361TANK . �S <br /> ✓ - - <br /> /�/l N P. TOP OF FILL TO PROD. AT ARRIVAL T'/ <br /> G. IOP OP FILL TO TOP OF TANK Z7_r�yz-- <br /> H. IMr4 ITELT0'BOTTOM'OF TNR - <br /> " 11Z..�ii <br /> ^ '/ ' <br /> It <br /> 1175 OR PSI PER INCH OF PRODUCT •O�� <br /> TANK W - TEST HEIGHT PRESSURE FORMULA <br /> E � <br /> M. PSI PSI MET ET PSI <br /> REMARKS: `— a e4 -/ <br /> d !v <br /> r � <br /> THE FINAL TEST PERIOD AS SHOWN ON THE ATTACHED COMPUTER GENERATED DATA REFLECTS A <br /> LOSS / CAIN OF:-U37 GALLONS PER HOUR, WITH A 99% CONFIDENCE LEVEL OF +/- !JCJ GPH, <br /> USING THE HORNER EZY CHEK II METHOD OF TESTING THE RESULTS AS SHOWN A WITHIN <br /> NOT WITHIN THE STATE OF CALIFORNIA AND E--NEPA 329 GUIDELINES OF MAXIMUM L OR" <br /> GAIN OF .05 GALLONS PER HOUR FQRANK SYST W TO BE CONSIDERE TIGH <br /> INTEGRITY TANK TESTING SYSTEMS, INC. 166 FRANK WEST CR. <br /> STOCKTON, CA 95206 (209)6-8036 or (800) 262-8378 <br /> CERTIFIED TESTER G��7/�`� TEST DATE �}'� <br />