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WORKSIIEET FOR SUMITTAL TO GOVERIMENTAL AGENCY <br /> oW11ER/orERA2oR Sr'.rtJ �it!/t"j2� S'Cht- ,d/�'t- _ LZ �(/ <br /> RITE. ADDRESS t <br /> CITY S Tz7 clG r D� J '-�51 , COUNTT_ <br /> MAILING ADDRESS 9v�Z©S <br /> SITE AGENT �LfjS LE7J/� w <br /> //�� <br /> TELEPHONE �) 4�• gO¢� <br /> ARRIVED TEST SIT0/'pNOURS TANK LOCATION S /2*vjIC v*cL TRODUCT_ <br /> DATE/i IME STORAGE fILt/A N AllrRomct LEVEL AT ARRIVAL IS INCpF.S BFLtn7 TOF Of WILL NOMINAL TANK RitE <br /> TANK MATERIAL / APPROK. TANK A�T TRS, ftt.LSI7.F./TIFF. ¢ UDERfILt CONtAtIRITftT iTFF. �/� �-o <br /> Art GRAVITT YJ <br /> Z AT DF.G, T. • AFI CRAVITT era ! 60F COEFFTCIENT or nrANSION of .000 4.T/7 / • COE _Y_S Z• <br /> VISARLE VEING ArrREARS TO BE AT, FILL END. FILL OFOSITE END RAS BURr TT,RE, RA�JS�'NALL CRECK. UNKNOWII. OTHER <br /> VISABLr. VAPOR TRAPS TO BE BLED, BAIL CHECKS, MANWATP. RETURN LINES, OTHER <br /> PHASE II VArOR RECOVERY STSTt?I, BALANCED..� ASFIMTOR ASSISTED. LANG RUN WELLS. MAl1IFOLDED,( pOpEJ OTHER <br /> rlRtrtm STSMI SUCTION, TUMINE MAKE 044EV � MODEL �/� FIFE LINE LEAK Detec/tor tS ILO; NOT AEFLtC <br /> GNARLED SItP. 2-/20 EST. LINE gUAITTITT PRODUCT ADDED 7O ft-00D STSTFM S SYSTEM TONAL CALLO"AGE Z/3-6 <br /> AMBIENT COHDITI�OHnS, TrM, rNFIEST� rOnTr.ST ® OVDT RAtNtNG, UTHDT. am", NICRT. OTHER <br /> 4 PSI DROP-/ HOURS TEST 70 START/245nn R.5 PSI TO BE HAIRTAINF.H ON TANX NOTTOH DURING TEST PERIOD — ¢r� <br /> r1at <br /> A. CPADP. TO TAMC BOTTOM /i 5 3" <br /> 2 1. GRADE. TO TAME TOP <br /> of PA.OF C. TA"x DIAVF.TER <br /> 77777: SD. TEST I.P.VP.L APOVE CPADR 1 <br /> 6. E. rx1ERNAL CROUlM MATER APOVE TAN[ tlJ <br /> r. Tor Or FILL TO rADn. AT ARRIVAL <br /> C. Tnr Or FILL FO TOP Or TAMC �4/ <br /> C�� N. T?TT^I.NTEL-Te 10"1" or TANt , <br /> �+y( RATtR trm- <br /> rSl rP.R INt71 or FIt1011Cr <br /> 1 TANx •..I " / TEST HEI,iR PRESSI11lE rVPlR1LA <br /> R.— _q.Ff <br /> _ <br /> . FSI E r51 NFt �S1 <br /> Rr•.r1ARKs 11 <br /> RESULTS <br /> HE FINAL TEST P .11101) AS S11014N ON THE AT.'TACIIEU COIICUTER CENERA'TEU UAT'A REFLECTS A <br /> OS / GAIN OF: /•O�� GALLONS PER HOUR, WTTll A 99% CONFLUENCE LEVEL OF EI,II, <br /> THE KORNER EZY CIIEK II TEST METHOD COWLIF.S WITH EFA AND THE STATE. OF CALIFORNIA PERFORMANCE STANDARD OF 0.05 GrH <br /> FOR TANK INTEGRITY TESTING. (SECTION 2643 CALIFORNIA CODE OF REGULATIONS) BASED UPON THIS STANDARD, THE RESULTS <br /> SHOWN ABOVE: DOES DOES NOT INDICATE AN UNAUTHORIZED RELEASE EQUAI, TO OR GREATER THAN THE 0.05 GFH STANDARD. <br /> INTEGRITY TANK TESTING SFR ?CF,S, 166 FRANK WEST CIRCLE,, STOCKTON, CA., 95206,A, (209) 466-8036 or (800) 262-8378 <br /> CERTIFIED TESTER -_ STATE LICENSE A q() rf(Jy� TEST DATE <br />