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WORKSHEET FOR SUBMITTAL TO GOVERNMENTAL AGENC�Y� <br /> OWNER/OPERATOR ��'' SITE ADDRESS l7S� N lUA}1 <br /> CITY COUNTY •.�—ou !pzj4azA_j <br /> MAILING ADDRESS 9 405 <br /> SITE AGENT A4lNJ A64-7"ti TELEPHONE — 2L <br /> ARRIVED TEST SIT�NOURS TANK LOCA�/T7iION/NUlER z <br /> � J� � "�_ <br /> DATE/TIME STORAGE FILLPPZ ' ODUCT LEVEL AT ARRIVAI�I NOES BELOW TOP OF FILL. NOMINAL TANK SIZEE /DODO <br /> TANK MATERIAE APPROX. AGRe"(ATTAYRS. FILL SIZE/TYPE_�74MRFILL CONTAINMENT TYPE '•���//• <br /> API GRY'57 � <br /> AVIT _ATDEG. F. • API GRAVITY OP5�B SOF • COEFFICIENT OF EXPANSION OF: IMID /(J�i.J. COE OFS(L -l--- <br /> VISAELE VENTING APPEARS TO BE AT: FILL END, <qL OPPOSITE E HAS BURP TIRE, UNKNOWN, HAS A MALL CHECK, OTHER <br /> VISABLE VAPOR TRAPS TO BE BLED: SALL CHECKS. NARRATE. OTHER AIO.c--'ke� <br /> RUSE If VAPOR RECOVERY SYSTEM TYP BALANCE ASP A R ASSISTED LONG RIR! WELLS NANIFOLDED NONE DATA <br /> PUMPING SYSTEM: S�UUCTI�TI ppnnTUNIS IN _ MODEL PIPE LINE NEAR DElEL70PS�M <br /> CHARTED TANK SIZE-ift? ESTIMATED LINO QUANTITY '/9� PRODUCT ADDED TO FLOOD SYSTEM_L_SYSIEM GALLONS TOTAL /a��I ✓ <br /> AMBIENT WEATHER CONDITIONS: TEMPERATURE PRATESY_!,-7'OST TEST MIND RAINING CLOUDY NIGHT OTHER <br /> L�9 <br /> SYSTEM FLOODED1Q�vHOURS .A PSI DROP Hours PSI TO BE NWNTATNED ON TANK BOTTOM DURING TEST PERIOD <br /> A. GRADE TO TANK 110I90M <br /> . Q9 B. GRAN TO TANK TOP <br /> �J <br /> C. TANK DIAyETER <br /> 6 PRI DE <br /> D. TEST LEVEL AMOYE CRADB .. . I • <br /> &III Z <br /> e. BOT�� cR01MD 110.Rx .033BLTPPSSI/�/� P. TOP OP FILL TD PROD. AT ARRIVALAd 4 '" G. IOP OP FILL TO TOP OP TANK �7_H. TTSTr4lTEL_TO'BOITOM'OF TANK �9� ^ '/PSI PER INCH OF PRODUCT .0�TEST HEIGHT PRESSURE PORKIA <br /> H. PSI PSI MET PSI <br /> REMARKS. <br /> r i <br /> THE FINAL TEST PERIOD AS SHOWN ON THE ATTACHED COMPUTER GENERATED DATA REFLECTS A <br /> LASS ! CAIN OF;-667 GALLONS PER HOUR, WITH A 99% CONFIDENCE LEVEL OF +/- CJCJ GPH. <br /> USING THE HORNER EZY CHEK II METHOD OF TESTING THE RESULTS AS SHOWN A WITHIN { <br /> NOT WITHIN THE STATE OF CALIFORNIA AND E--NFPA 329 GUIDELINES OF MAXIMUM L OR" <br /> GAIN OF .05 GALLONS PER HOUR FQRANK SYST W TO BE CONSIDERS TIGH . <br /> INTEGRITY TANK TESTING SYSTEMS, INC. 166 FRANK WEST CR. <br /> STOCKTON, CA 95206 (2209)) 6-8036 or (800) 262-8378 <br /> CERTIFIED TESTER TEST DATE <br />