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Data Chart for Tank System Tightness Test - <br /> petro Tite <br /> PLEASE PRINT TANK TESTER <br /> 1. OWNER Prop.ny i <br /> Tlnk(1) O / r Add / // / R.0 <br /> T0`�rKT / � <br /> N.m. ------_ Add/. . q.0/... <br /> 2. OPERATOR <br /> N.m. Add/es. T.I.DhOne <br /> 3. REASON FOR 4411) <br /> TEST <br /> (Explain Fully) <br /> ) <br /> "i <br /> 4. WHO REOUESTED <br /> TEST AND WHEN "'m' Tin. Comwny or Atlil.tlon oa. <br /> Add— T.I.ohone �. <br /> 5. WHO IS PAYING <br /> Company.Agency or Indi.iduel Perron Autho/Irina Tin. T.I.ohon. <br /> FOR THIS TEST? j <br /> i <br /> r erring Address City Sul. Zfo <br /> Attention of: order No. Oth.r Innruction. <br /> Identify by Direction- Capacity Brand/Supplier Grade Approx.Ag. Steel/Fiberglass { <br /> 6. TANK(S) INVOLVED SOr> �a�� � <br /> psi <br /> r C) vire <br /> Location Cover Fills Vents Siphons Pump <br /> 7.- INSTALLATION <br /> DATA CIO- �-��� CO I�Pj1� <br /> North Inside driveway. Concrete,Bieck Too. Sire,Tit.lill t.,0,00ro0 Suction,q.mote, <br /> me <br /> Real of au tion,etc. Earth.etc. IUDes,Remote Fills Sire,Manilolded Which tanks f Make if tnown 3 <br /> 8 .:UNDERGROUND Is the water over the tank ir )j <br /> WATER. Depth to the water table Yes <br /> Tanks to be filled - hr. Date Arranged by <br /> N.me <br /> 9 _ FILL UP, Tare DhDn. <br /> ARRANGEMENTS Extra product to"top olf–ane tun TSTT. Now and who to provider Consider NO Lead. <br /> Terminal or other contact - <br /> for notice or inquiry <br /> - _ Como.ny Name Tele Dhone <br /> 10. CONTRACTOR, <br /> MECHANICS. <br /> any other contractor _ <br /> .involved - - <br /> 11 OTHER <br /> INFORMATION <br /> OR REMARKS <br /> t Additional information on any items above.Officials or others to be advised when testing is in Progress or completed.Visitors or observers present <br /> during test etc. <br /> Tests were made on the above lank systems in accordance with lest procedures prescribed for prirO T11P - <br /> 12 TEST RESULTS as detailed on attached lest charts with results as follows: <br /> Tank Identification A Tight Leakage Indicated - Date Tcsted --_–.— <br /> ou> "/O fI//— �Cr he <br /> o G vat ------ <br /> I <br /> This Is to certify that these tank systems were tested on the dale(s)shown.Thos Indicated a"Tight'-meet the crilerfa catabliahed by <br /> 13. CERTIFICATION the National Flre Pro1�n Asoctalfon Pamphlet 329. <br /> I 1orre `V `LJ[ ToM1n h�1 / �s _Be.ck.�x_Sndustra�s;�C--n. 6E --�--� - <br />