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Yew I Q . DATA CHART <br /> state 4 <br /> .MO � � I I��v�i}� /t of •s <br /> Day <br /> 1 492 <br /> DTEST LOCATION ,^TE OF Sate OWNER PETRO-CHECK <br /> INC. <br /> 1 LOCATION: \ ) Y►/ a i n ST A H�►� 4ate ��1 - <br /> Suset No.and/or Corner City Sun <br /> 2 OWNER: <br /> Nang Address Nepresenledve PoMtkon <br /> 3 OPERATOR: �� I I �` ► G a�c� — <br /> Narrte Dealer,Mgt.or Other Address(if different then Location) <br /> 4 REASON FOR TEST_ �W-p� <br /> 5 TEST REQUESTED BY: 61"grey <br /> NerM Position Order No. <br />:. SPECIAL INSTRUCTIONS: <br /> 7 CONTRACTOR OR COMPANY MAKING TEST yv--- �y,`xd 0-4s A .. <br /> �K� <br /> MECHANIC(S) NAME ,t 4. <br /> S IS A TANK TEST TO Of ® YES S MAKE AND TYPE <br /> MADE WITH THIS LMIE TEST? ❑ NO PUMP OR DISPENSE �•/ <br /> COVER �ryN/► 2�� APPROXIMATE <br /> 1� r( �O I) w 6i ro BURIAL DEPTH <br /> 0 WEATHER TEMPERATURE IN TANKS 'F 'C OVER LINES <br /> Concrete.Black Top.Ne. <br /> 14 PRESSURE 15 VOLUME <br /> 11 IDENTIFYT13 LOG OF TEST PROCEDURES, <br /> 12 TIME READING <br /> EACH UNE 2 AMBIENT TEMPERATURE, psi OR kPa NET <br /> AS TESTED I IME WEATHER, ETC. BEFORE AFTER BEFORE {AFTER CHANGE r_ <br /> I <br />