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WOR <br /> KSHEET FOR SUBMITTAL TO G <br /> OV <br /> ERNMENTAL AGENCY / �J <br /> 0L17ER/OPERATOR 5720 � i�/ � S��j/ D/dam SITE ADDRESS ` Z� /�J �G <br /> C I TY sTOC�ra�cJcol <br /> nlrY <br /> HAILING ADDRESS �7 <br /> SITE ACQTI TELEPHONE <br /> ARRIVED TEST SITOUFiS TANK LOCATION S Z PRODUCT <br /> DATE/TINE STORAGE FILLET) PRODUCT LEVEL ATTARRIVAL_.,,/7INCIES BELOW TOP OF FILL NOMINAL TANK SIZE /Z-40O Q <br /> TANK MATERIAL e APPROX. TANK AW/-/I' <br /> TRS. FILLSIZE/TYPE 4 OVERFILL CONTAINMENT TTPE_4tZ:�1�d <br /> API GRAVITY 32 AT —_L_ DEC. F. - API GRAVITY OF3zlir@ 60F - COEFFICIETIT OF EXPANSION OF .000 .'5L7F_ COE 413 <br /> VISA13LE VENTING APPPSARS TO BE AT: FILL END, ILL OPOSITE E2 HAS BURP TUBE, HAS BALL CHECK, UNKNOWII, OTHFR <br /> VISABLE VAPOR TRAPS TO BE BLED: BALL CHECKS, MANWATS, RETURN LINES, OTHER 7-z— wj c-2A44' <br /> PRASE II VAPOR RECOVERY SYSTE7I: BALANCED, ASPIRATTOIIR ASSISTED, LONG RUN WELLS, MANIFOLDED, ONE OTHER <br /> PUMPING SYSTEM: SUCTION. IN MAKE �� MODEL / PIPE LINE LEAK Detector SCEDN0; NOT APPLTC <br /> CHARTED SIZE `2/� EST. LINE QUANTIIT -5-PRODUCT ADDED TO FLOOD STSTEH,5- SYSTEM TORAL GALLONAGE <br /> A?43IQIT CONDITIONS: =* PRE � <br /> TEST� STEST , RAINING, WINDY, BREEZY, NIGHT, OTHER <br /> .4 PSI DROF'4 W! : T/riC <br /> OURS TEST TO STAR /HOURS PSI TO BE MAINTAINED ON TANK BOTTOM DURING TEST PERIOD 4•f PSI <br /> A. GRADE TO TANK BOTTOM <br /> O B. GRADE TO TANK TOP 4 / <br /> C. TANK DIAIfETER /Q <br /> 6Pi4,0E <br /> D. TEST LEVEL ABOVE GRADE Z_3 <br /> ALE. EXTERNAL CROLWD MATER ABOVE TANK <br /> BOTTCH IN. X .0361 PSI <br /> s} S o F. TDP OF FILL TO PX00. AT ARRIVAL /7 <br /> C. TOP OF FILL TO TOP OF TANK <br /> lis <br /> TLTr:.LBVEL'TO"BOTTOM OF TANK /��PSI PER INCH OF PImDUCTE / <br /> TEST 12EIGFfT PRESSURE FORMJLA <br /> / K <br /> Rcrinxxs H. PSI E. PSI NET PSI <br /> n L;%o L i ff,'*4aa,-D- <br /> MAR <br /> DCta�Y►IT�/QCC��VI�J��? <br /> ENTHUNM <br /> RESULTS <br /> THEAL TEST PERIOD AS SHOWN ON THE ATTACHED COMPUTER GENERATED DATA REFLECTS A <br /> LOSS / A OF:--�I-1 GALLONS PER HOUR, WITH A 99% CONFIDENCE LEVEL OF +/- 00L gph. <br /> THE HORNER EZY CHEK I 0 COMPLIES WITH EPA AND THE STATE OF CALIFORNIA PERFORMANCE STANDARD OF 0.05 GPH <br /> FOR TANK INTEGRI, STING ( CTION 2643 CALIFORNIA CODE OF REGULATIONS) BASED UPON THIS STANDARD THE RESULT <br /> SHOWN ABOVE: Ml DOES NO INDICATE AN UNAUTHORIZED RELEASE EQUAL TO OR GREATER THAN THE 0.05 GPH STANDARD. <br /> INTEGRITY TANK TESTING SER ICES, P.O.BOX 6913T6 STOCKTON, CALIFORNIA, 95269 (�2209) 474_1375 or (80 ) 26 8378 <br /> CERTIFIED TESTER A A STATE LICENSE N Q (J(j TEST DATE <br />