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, <br /> Data t,iart for lank System lig&.,ajess <br /> petro TiteuNv Zuo <br /> Pu ARI PRINT LANK TESIER <br /> 1. OWNER Proven, El <br /> x•.r•jnV1R0MENTAL <br /> News _ <br /> 2. <br /> AeerM. ----_—__— rk.o... t• <br /> .NOM <br /> OPERATOR <br /> N.rw. ye,•.. - Cf-i �il' �St-r' 1 �S i- 7-�; L <br /> T.aeNe, <br /> 3. REASON FOR l)t"J'1-.7.C.,, ,r /C., r t,F,. <br /> TEST - i u.,« <br /> (Explain Fully) <br /> ;W'HO <br /> REOUESTED �wu l � '.. r� : C r t.. <br /> AND WHEN "'"r' ���— r o c c, ' , <br /> TN.` Carwcr..y er A utaa— <br /> Oa. <br /> T.`.ONeN. <br /> 5. IS PAYING 44,E C - <br /> FOR THIS TEST? co^o.Nt.Ao.nce e,tne...ewt 1,q ti/L !a` -C- Gt•- <br /> t,n�..e bOi•s. T.t.eNen. <br /> Crrt St... 2ta <br /> A n•ntiow ext: <br /> 0,0-- <br /> Ne. tH..r tn.t.rc4ene <br /> ld.ntity by Direct on Capacity raQe <br /> 6. TANK(S) INVOLVED i 't°p'Oi �ko' st.etrFib..Ql.ae <br /> r <br /> f ovation Cover Fills Vents <br /> SipMnes rC, <br /> 7. "tSTALLATIOF; 5<< I�-+�c err�scil <br /> 4TA � '1 Z <br /> ( Moat,Inside Ari.•...•r Co•. •e,.,#I,-.ToD. SIL.Tii•r,tt•..k.,Oros <br /> It•.�or autwn,etc E.nk n. .ubh.n•.Nor.Fin. Sucrwn•no-me, <br /> Sin.kr►Mela.d WNicn tank.T ai.k.N kr%a- <br /> 8. UNOERCRQUNO <br /> WATER es the water ovr Me tank I <br /> Depth to the Water tab• ...�4U F I <br /> Yas �No <br /> S. Fill-UP Tanks to be tilled h(. Date Arranged by <br /> ARRANGEMENTSNe"' T«• <br /> Extra product to`IDG off-and run TSTT. Now and who to provide l Consider NO Lead. <br /> Terminal or other contact <br /> to,notice a inouiry <br /> Comoanr <br /> "•"•e Te4onen. <br /> 10. CONTRACTOR. <br /> MECHANICS. <br /> any other contractor <br /> invWved <br /> 11. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> Addrtronal mfcrrtnstrpn on any nems lbove 011.c,.is a othe.s to be edvis•d wMn test K <br /> dwir.p test etc "tg �+prog.eu a completed Vrs,tors a observes ileum <br /> Tact wrere rnade on the above tank systema in accordance with tett <br /> plo <br /> 12. TEST RESULTS as detalled an attached test charts with regults as follow, prescribed til I10 r <br /> Tank Identif"6on TVht leakage Ind.cned <br /> C)'3 F, <br /> r-P N Date Tested <br /> n � 't,GO ail CNS12_G- <br /> �..n�TrT' <br /> r_PN <br /> This h to ear"that Mese tank systems wen d -N <br /> ht*on the 11a(a)shown.Those lndlcaled sa" ht•'meet L vtlwL ON,& IN by <br /> Sy <br /> 13. CERTIFICATION the National Fie Protection A—_48110" pamphlet 379. <br /> 4Ce�y u <br /> `t`1inr't <br /> !� to r+e C��•two• C.w.e•nr •r "�'r^�' 1 <br /> ��--- -- '1----- K tilIJj S <br /> Se.w an .✓Tr..nw i:,�Nn,r..nr - <br /> fwnvv wee.•..- ------ <br />