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c`,arnnncn R_ >; Hwy I ) T_,oai Ca. �'�-9� -- LA Name of Supplier,Owner or Dealer Address No.and Street(s1 City State Date of Test ` I L; , -a 15. TANK TO TEST 15a. BRIEF DIAGRAM OF TANK FIELD 16. CAPACITY rpfe S:� Station Chart Y d�r Nominal Capacity /O DDD ❑ Tank Manufacturer's Chart M Company Engineering `7 Identity W position SGallons Data ''Y ❑ oNO2� - CucA P, ee A t t a c h e By mo,l accurate 7J^�({1 O ❑ Charts supplied with r+ Brand and Grade -� CapaCity Chart wadable ❑ Other Gallons rn Total Gallons 17. FILL-UP FOR TEST - Gallons �1 ea .Reading Stick Water Bottom -.[ Delors Fill-up in. in. Inventory to`A' Gallons Tank Diameter . 18. SPECIAL CONDITIONS AND PROCEDURES TO TEST.THIS TANK ❑Water in tank (J Ur ls)being tested with LVLLT See manual sections applicable.Check below and record procedure In log(27). 2�Hlgh water table in tank excavation 73 Lee maximum allowable test pressure for all rests. 19. TANK MEASUREMENTS FOR _Transfer total to line 25e Four pound rule does not apply to double.M Med tanks. TSTT ASSEMBLY 21. VAPOR RECOVERY SYSTEM ❑Stege I Stags It Complete section below: Bottom 0l tank to grade'............................ �� In. Add 30-for-r probe easy........................... 30 in. 24b.COEFFICIENT OF EXPANSION - �D 1. Is four pound rule required? Yes ❑ No Total tubing to assemble-approximate............. in. RECIPROCAL METHOD �Ei14E1� d 20. EXTENSION HOSE SETTING Type of Product. 2.Height to 12-mark from bottom of tank �-Uf�In Hydrometer Employed........................... H �_ //tea Tank top to grade'.................................. —In. ....... 1 V Extend hose on suction tube 6'or more Temperature In Tank 3.Pressure at bottom of tank PSI. After Circulation........................................ r _ below tank top...................................... In. QyI 3,7Temperature of Sample................................. 0 -iJ�—'F 4. Pressure N top of tank -Y4/ P.S.I. -if Fill pipe extends above grade.use top of Illi. •� 22. Thermal-Sensor reading after circulation Diff«encs NF)......................................... 'F 10 157-17 In. digits 0� �q(�i Depth of burial -A Observed A.P.I.Gravity ................................. Between Cj-, 23. Digits par-F in range of expected change digits Reciprocal Page Tankdia 1 �� _ COEFFICIENT OF EXPANSION (Complete after circulation) 923,2 ✓`�7y 24a. Corrected AP.I.Gravity Total quantity In Reciprocal Volume charge in A full tank(16 or 17) this tank par'F Water table v In. Transfer to Lina 28a. Observed A.P.I.Gravity................................... NOTES: Hydrometer employed................................... H O 24c.FOR TESTING WITH WATER sae Table C a D m o 0 Observed Sample Temperature -F 0 Z Z O O Corrected A.P.I.Gravity Wates Temperature altar Circulation Ln t - @ 60'F.From Table A.................................... Table C................................................ 'F Ln CO Coefficient of Expansion Coefficient of Waw 01 O ng to for Involved Product Table D................................................ O N Frorin The above celculatlona ars to los used for dry Boll conGtloTable B............................................ establlsh a positive pressure advantage,or when using the four pound I Added SuAectsM? ❑Yes No Traveler COE to Lifts 25b. rule to Compensate for the presence of subsurface water In the tank Transfer COE to Line 25b. ares. Refer to N.F.P.A. 30. Sections 2-32.4 and 2-7.2 and the tank 25. (a) x (b) = (c) gallons manufacturer regarding allowable system test pressure*. Total quantity In Coef Clem of expansion for Volume change In this tank lull tank(16 or 17) Involved product par-F k= 9 /� 11 26. ��A , A M� Alm <e ? This Is /I(J6•/�/ 102 (23) C Volume change Par'F(26 or 24D) Digits 23) Compute to 1 decimal place Intact Volume change Per dl pH factor(a) Range( s