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ns IT, <br /> DATA CHART IZ LEI <br /> For Use With <br /> T& APR 2 .2 1903 <br /> �NVIRONMENTAL HEALTH <br /> I LOCATION: SI <br /> so. d/.,Co.., C'N Sim'. <br /> O 2 OWNER: 0 <br /> Add-' <br /> 3 OPERATOR: c 0 <br /> N... O.M."mg-,0'.., Add-,(it 4114-1 1.-L-d..) T...i-.No. <br /> cr) <br /> 4 REASON FOR TEST <br /> z <br /> 5 TEST REQUESTED BY: <br /> S SPECIAL INSTRUCTIONS: <br /> 7 CONTRACTOR OR COMPANY MAKING TEST <br /> MECHANIC(S) NAME <br /> 8 IS A TANK TEST TO BE YES 9 MAKE AND TYPE OF <br /> MADE WITH THIS LINE TEST? PUMP OR DISPENSERS <br /> A d NO <br /> 2 COVER APPROXIMATE <br /> 10 WEATHER—) i4"f'id TEMPERATURE IN TANKS -F—'C MR LINES—C-Z'T' BURIAL DEPTH <br /> co--.sl,ck Too. <br /> IDENTIFY 12 T 13 LOG OF TEST PROCEDURES, 14 PRESSURE is VOLUME 15 TEST RESULTS + Ll <br /> EACH LINE TIME AMBIENT TEMPERATURE. P,i OR kP. READING <br /> (MILITARY) ET <br /> AS TESTED WEATHER. ETC. BEFOR AFTER BEFORE AFTER CHANGE CONCLUSIONS, REPAIRS AND COMMENTS <br /> X045 Oro -, 00-)o <br /> 1100 45 ` 15 6300 0300 0000 - 7 <br /> LAS 3(DO 2L m,C) <br /> Li 0 =qC 0 <br /> 111;5 y5 u5 ,eaa0 ,c�o,0 f o000 - . 00't0 ���I <br /> 14150 70010 bL2 6 bc, (-,) - <br /> 350 inso t=o CD 0 <br /> L15 ,eAo ,03Q e) Gow <br /> Lk to 03o .0350 10010 <br /> Jo�() p <br /> 45 - - 41 110440 04 101 1 0060 <br /> 12 15 45 <br /> 4 y <br /> L�5 C) <br /> LA C, (�39(D '03v 0mo <br /> 11 45 4 LAIC., 10390 a390 t,©000 (3c)a <br />