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RecertifAion <br />Underground <br />Tank Report <br />CURRENT OWNER �, t <br />ORIGINAL OWNER WHEN NEW YES ❑ NO ❑ <br />The following is a schematic and report of the tank's <br />manway and fittings orientation and condition upon com- <br />pletion of work performed by a qualified O/C Tanks Field <br />Service Technician. <br />Manway <br />�-" located at�c�w tG / vs) <br />" located at ( ) <br />" located at ( ) <br />Project R- �(-_ JW <br />Sheet 1 of 2 <br />DATE G Y.-"?., J_ — �, V <br />TECHNICIAN JJ t� <br />U.L. NUMBER <br />MFG PLANT /V " -2J_ <br />MODEL SIZE /620y <br />W/Def Plate <br />Fittings:�t ��,'7-v Y N <br />A - ( 1) located at �� A 110 JC <br />tit located at ' 3 <br />( ) located at <br />( ) located at <br />( ) located at <br />( ) located at <br />( ) located at <br />( ) located at <br />( ) located at <br />( ) located at <br />(A) Added or replaced (B) Existing , <br />This view establishes the perspective for all <br />comments in this report <br />L Endcap: Hemi -Q Dish ❑ <br />Total number of Fittings <br />Total number of Manways <br />Total number of Deflector Plates <br />All internal joints <br />have been layed-up. Yeses-- No ❑ <br />Technician <br />Owner or Representative <br />Pub. No. 4 -PE -13355:1 -A Litho in U.S.A., February 1989 <br />Copyright "E: 1989 O/C Tanks Corp. <br />R Endcap: Hemi ❑ Dish -t�- <br />Tank successfully <br />passed air test. Yes-;;- No ❑ <br />Installation Instructions , <br />encapsulated. Pub. No. <br />Recertification Label <br />attached to tank. Yes,- No ❑ <br />Distribution: <br />White Copy: To be retained bytankowner. <br />Yellow Copy: To be retained by O/C Tanks plant. <br />Pink Copy: To be retained by O/C Tanks Toledo. <br />