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WORKSHEET FOR SUBMITTAL TO GOVERNMENTAL AGENCY <br /> O:TIER/OPERATOR ��jLJ ����/�//�--__� Cr� SITE ADDRESS �Z /�C c� /E//•C�i��� <br /> CITY J ���� ! COUNTY <br /> MAILING ADDRESS ,/,� �] <br /> SITE ACENT G�f-/�LeLZS L_�!/�/L��/[�7�_ TELEPHONE )_ <br /> ARRIVED TEST SI�7��-R�RS TANNMy LOCATION /l� T/�f� r PRODUCT <br /> DATE/TIRE STORAGE FIum4ei "HRODUCT LEVEL AT ARRIVAL��INCHES BELOW TOP OF FILL NOMINAL TANK SIZE_f �� <br /> TANK MATERIAL <br /> rr��rf�-------APPROR. TANK Ack�TRS. FILLSIZE/TYPE C OVERFILL CONTAINIt TYPE <br /> API GRAVITY 7 AT,�5Z DEC. F. - API GRAVITY OF � @ 60F - COEFFICIENT OF EXPANSION OF .000 942. 1- - COE �T <br /> VISA-BLE VENTING APPRPARS TO BE AT: FILL END, I. OPOSIT�' r,3 , HAS BURP TUBE, HAS BALL CHECK, UNKNOWN, oTRFR <br /> VISABLE VAPOR TRAPS TO BE BLED: BALL CHECKS, HANWAYS, RETURN LINES, OTHER <br /> PARSE II VALOR RECOVERY SYSTEM: BALANC �A"SIPIRATOR ASSISTED, LONG RUN WELLS, HANIFOLDED, NONE, OTSER <br /> PUT IG SYSTEM U�� TURBINE HAKE �r�J i/�� MODEL W4IPE LINE LEAK Detectors YES, N0; OT AFPLIC <br /> CHARTED SIZE�Z;' EST. LINE`/QUANTITI�p PRODUCT ADDED TO FLOOD SISTEH�SYSTEM TORAL GALLONAGE �� <br /> AMBIENT CONDITIONS: TEMP: PRETEST60 POSTEST�6DC,OUDY RAINING, WINDY, BREEZY, NIGRT, OTHER <br /> .4 PSI DRO/�OSCURS TEST TO STAR4/—'C?OHOURS PSI TO BE HAINTAINED ON TANK BOTTOM DURING TEST PERIOD ¢,3 PSI <br /> A. GRADE TO TANX BOTTOM <br /> O ++ B. GRADE TO TANK TOP <br /> 6 Pig 0E C. TANK DIAVETER <br /> --�.. D. TEST LEVEL ABOVE GRADE <br /> GAJ / E. EXTERNAL GROUND MATER ABOVE TANK /7J <br /> F- ` BOTTOM IN, K .0361 PSI <br /> _ N C/ F. TOP OF FILL TO PROD. AT ARRIVAL <br /> / C. TOP OF FILL TO TOP OF TANK <br /> C �S N. TTST:.IBVEL'TO"BOTTOM OF TANK <br /> A21 <br /> MATER WIDE <br /> ✓ PSI PER INCH OF PRODUCT <br /> E TANK -tP '+ / TEST NEIGIPT PRESSURE FORMULA <br /> RErIARKs N. PSI E. PS1 NET PSI <br /> . � vJ? <br /> ✓; <br /> MA R <br /> PE <br /> �NVII� <br /> RM1 / f�Vlf'F , N <br /> RESULTS <br /> REC <br /> THE FINAL TEST PERIOD AS SHOWN ON THE ATTACHED COMPUTER GENERATED DATA REFLECTS A <br /> LOS / GAIN OF:!jX�-GALLONS PER HOUR, WITII A 99% CONFIDENCE LEVEL OF +/- gph• <br /> THE HORNER EZY CHSIHOD COMPLIES WITH EPA AND THE STATE OF CALIFORNIA PERFORMANCE STANDARD OF0.05 CPH <br /> FOR TANK ZNTEGTECTION 2643 CALIFORNIA CODE OF REGULATIONS) BASED UPON THIS STANDARD THE RESULT.SHOWN ABOVE: >�dZINDICATE AN UNAUTHORIZED RELEASE EQUAL TO OR GREATER THAN THE 0.05 CPH STANDARD. <br /> INTEGRITY TANK TEES, P.O.BOX 691376 STOCKTON, CALIFORNIA, 95 69 (209) 474-1375 or (80 )) 26 8378 <br /> CERTIFIED TESTER2Z/ STATE LICENSE M ��� TEST DATE /� <br />