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WORKSHEET FOR SUBMITTAL TO GOVERNMENTAL AGENCY <br /> OWNER/OPERATOR rl y Mi>v l /4/a-Ae/ SITE ADDRESS Z7S76 <br /> CITY COUNTY <br /> MAILING ADDRESS ;5- 2.5 <br /> SITE AGENT ti TELEPHONE ('l jj •— 27Z <br /> ARRIVED TESTslll�f T R LOCATiOM/MBlBR L✓L59—TA�aC / aRooucr �4dU <br /> DATE/TIME STORAGE <br /> FILLB �LPRODUa LEVEL AT <br /> ARRIVAL- L HC ES BELOW 70P OF FILL. NOMINAL TANK SIZE0 <br /> TANK MATPRIAI��/�/ � APPROT. AGE��YRS. FILL SIZE/TYPE OVERFYLL CONTAINMENT TYPE— <br /> An <br /> o <br /> API GRAVIlY1SGAT 47DEG. F. • API GRAVITY 0 'L B 60P - ODEPPICIENT OF EXPANSION OF: ^^^ lodASZ. COS OFS� i LL ✓ <br /> VISARIE VENTING APPEARS TO BE AT: FILL END, ILL OPPOSITE EN HAS BURP TUBE, UNKNOWN, HAS A BALL CHECK. OTHER <br /> VISABLE VAPOR TARPS TO BE BLED: BALL DOCKS, MANDATE. 07HER ��•UL'T <br /> RUSE It VAPOR RECOVERY SYSTEM TYPE:(BALANCED AS I�TO^R ASSISTED LONG RUN WELLS MAHIPOLDED NONE OWER <br /> PUMPING SYSTEM: SUCTION 7DIDfI MAKE f/^�_ 7 ? MODEL 17- <br /> 'J PIPE LINE NEM DETECTORS©M <br /> CHARTED TANK SIZE S ESTIMATED LINO QUART17T� 19{2 RDDUICT ADDED 70 FLOOD SYSTEM�YSTEN GALLONS TOTAL /O O D Z• '� <br /> AMBIENT WEATHER CONDITIONS: TEMPERATURE PRBTESY=-POST TEST41�RAINiNG CLOD WINDY IGHT OWER_ <br /> SYSTEM FL.00DFDI�V'1-5HOURS .6 PSI MP_HOURS---' PSI TO BE MAINTAINED ON TANK BOTTOM WRING TEST PERIOD <br /> A. GRADE TO TANK BOTTOM <br /> Q 36 B. GMDS 70 TANK Ta /��77yzy- <br /> C. TANK 01AWM IN <br /> 777/-77p - D. TEST LEVEL ABOVE G" .. .. 36 <br /> E%q —'(, 2 0, a E. EKTERMAL GRDU�'WATER ABOVE TANK <br /> BOTTOM_(0 1*. 1 .0561 PSI • �0 <br /> J'l6t�+Y� P. TOP OP FILLTOPROD. AT ARRIVAL ]e <br /> G. PCP OF PILL TO TOP OF TANK <br /> 94/ H. TEST:LSVEL'TD BOTTOM OR TANK <br /> C� PSI PER INCH OF PRODUCT7 <br /> •0�� <br /> WATER IN GE <br /> TAR W _ TEST HEIGHT PRESSURE FORMULA <br /> 19 <br /> H. PSI PSI NET PSI <br /> REMARKS: <br /> `r <br /> THE FINAL TEST PERIOD AS SHOWN ON THE ATTACHED COMPUTER GENERATED DATA REFLECTS A <br /> LOSS / GAIN OF:-O-Z 99 GALLONS PER HOUR, WITH A 99% CONFIDENCE LEVEL OF +/- , 691 j GPH. <br /> USING THE HORNER EZY CHEK II METHOD OF TESTING THE RESULTS AS SHOWN ARE ITHI / <br /> NOT WITHIN THE STATE OF CALIFORNIA II A 329 GUIDELINES 0 XIMUM LOSS OR <br /> GAIN OF .OS GALLONS PER HOUR FOR TANK SYST TO BE CONSIDERED TIGHT <br /> INTEGRITY TANK TESTING SYSTEMS, INC. 166 FRANK WEST CR. <br /> STOCKTON, CA 95206 (209) 466-8036 or (800) 262-8378 <br /> CERTIFIED TESTERACL z✓ TEST DATE /z�Z Y <br /> H <br />