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A Data C�- •t for Tank System TigV' iss Test <br /> petroTI e <br /> PLEASE PRINT ANF. TESTEk <br /> I <br /> 1. OWNER Property ❑ �� [� l ,` <,-Z,3 �.�i + kp re <br /> [ �P <br /> resS <br /> Adds AepreNntetiv� I"-'-"� TNephene <br /> Tank(&) ❑ <br /> N.m! Address Rweeeenla h ve T N.Dr+in e <br /> 2. OPERATOR ���tc 4 Er ti' `4l�c vc.E - 5 ��. F z2 16 <br /> Name <br /> Address Te,eo•ane <br /> 3. REASON FOR t <br /> TEST <br /> (Explain Fully) <br /> 4. WHO REQUESTED � C .-,7 <br /> Title llut,Dn <br /> TEST AND WHEN G�� <br /> Address <br /> TeleD-.•M <br /> 5. WHO IS PAYING <' TZ � co/-L- �Arr^ �c�� < c?- L/ <br /> ComDa n r or Intlwr u)' r Person ulnor ng Trtie Te4D!one <br /> FOR THIS TESTI a < / s !n <br /> B,IImg Address Clty Sute Zre <br /> Attentroo of Order No Other Intra�cnon: <br /> Identify by Direction Capacity Brand/Supplier Grade Approx Age Siee Fibs—,lass <br /> 6. TANK(S) INVOLVED <br /> I <br /> I <br /> Locator: Cover Fills Vents Siphones pu-ncs <br /> 7. INSTALLATION <1� (b'tor"" <br /> DATA <br /> North inside dr,vewev, Concrete !lack Too. Sue,Tiuhll make.D,OD S�ct,on RrTot< <br /> Rear of stat.on,etc Earth,etc tubes Remote Fills tare.Mandolded Which unxs? WkP,•+•+.^�- <br /> 8. UNDERGROUND Is the water over the Una <br /> WATER Depth to the Water table ' ` I� h ��' ��� ❑ Y•` <br /> 9. FILL-UP <br /> Tanks to be filled hr Date Ananged by <br /> Nam! TNec^<�e <br /> ARRANGEMENTS Extra product to"top off"and run TM. How and who to provide? Consider NO Load. <br /> Terminal or other contact <br /> for notice or inquiryNeTrw^•^�r <br /> COTDanName <br /> 10. CONTRACTOR, ^�(J <br /> MECHANICS. — <br /> any other contractor <br /> involved <br /> 11. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> Additional information on any rums above Officials or others to be advised when testing is In progress or completed VrUtors a o{ser.*•s pee•sr <br /> during test etc. <br /> Tests were made on the above tank systems In accordance with test procedures prescribed for t The <br /> 12. TEST RESULTS <br /> S/d gilled on attached test charts with results as follows. <br /> j Dau Tared <br /> ianl Idenufiuopn TqM Leakage Indicated -- <br /> -j ,- i — • �3 1 — <br /> This Is to oenify that thew tank Systems were tested on the dela(s)shown Thoes Indicated as'Tipht'•no-1 ilea CAlavta aataDOMsad <br /> 13. CERTIFICATION the National fin Protection Association Pamphlet 329. (` <br /> 4 P.O Box ' Tee—tiu,y�onuauo,o7ew erw <br /> JIG, STGC!;TQ', CA g51Q1 <br /> �u'5);143�ft2Y— er»r <br /> Iae'r Nr, oTrw^,r <br /> Mr,er <br />