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05-71-1994 09:17R'l FROI1 <br />Reoertifi,,�.Aion <br />Underground <br />Tank Report <br />CURRENT OWNER <br />ORIGINAL OWNER WHEN NEW YES IL Nt <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' 5°11 rt:�' ___(6 <br />" located at — ( ) <br />" located at -_( ) <br />Fittings <br />W/Def <br />Plate <br />located at_��� <br />/ <br />Y <br />N <br />located at <br />(A) Added or replaced <br />(B) Existing, <br />TO 46!, ,_.1130 P. O2 <br />Project <br />Sheet 1 of 2 <br />DATE _1 -•� `� ` Ui' '�- <br />TECHNICIAN,A/G'L <br />U.L_ NUMBER - <br />MFG PLANT r, - <br />MODEL SIZE Lv <br />This view establishes the perspeCtive for all <br />comments in this report <br />L Endcap, Hem i 'Dish O <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. Yes No n <br />Technician ---A"`= <br />Owner or Representative--___— <br />n <br />epresentative_ —_____ <br />R Endcap: Hemi t , Dish,, <br />Tank successfully <br />passed air test. Yes No <br />Installation instructions 2_,? �2e 9 � <br />encapsulated. Pub. No. --,,- <br />o. <br />Recertification Label -?�� ..�` a <br />attached to tank_ ~ ` Yew' No r_ <br />DI!itrUwtlom <br />Wh7la Copy. T�G91Ftg�nad by tank nv,nnr <br />v uur...,hn•..r TnFw r4rainaA by OlC T�tik. 013111. <br />W/Def <br />Plate <br />located at_��� <br />/ <br />Y <br />N <br />located at <br />located at— <br />located at <br />located at <br />locatedlocated <br />at <br />at__ <br />---- <br />located at <br />located at <br />located at <br />This view establishes the perspeCtive for all <br />comments in this report <br />L Endcap, Hem i 'Dish O <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. Yes No n <br />Technician ---A"`= <br />Owner or Representative--___— <br />n <br />epresentative_ —_____ <br />R Endcap: Hemi t , Dish,, <br />Tank successfully <br />passed air test. Yes No <br />Installation instructions 2_,? �2e 9 � <br />encapsulated. Pub. No. --,,- <br />o. <br />Recertification Label -?�� ..�` a <br />attached to tank_ ~ ` Yew' No r_ <br />DI!itrUwtlom <br />Wh7la Copy. T�G91Ftg�nad by tank nv,nnr <br />v uur...,hn•..r TnFw r4rainaA by OlC T�tik. 013111. <br />