Laserfiche WebLink
WORKSHEET FOR SUBMITTAL TO GOVERNMENTAL AGENCY <br /> OWNER/OPERATOR 01 <br /> DRESS <br /> CITY <br /> /7 /i/ �L• �/ViOG. <br /> CITY COUNTY GLyt� Q <br /> HAILING ADDRESS <br /> SITE AGENT ,.yam , r¢ - <br /> TELEPHONE 7� <br /> ARRIVED TEST 9ITIOV49 HOURS TANK LOCATION PRODUCT <br /> DATE/TINE STORAGE. FILLED 17/A7PRODUCT LEVEL AT ARRIVALINCHES BELOW TOP OF FILL NOMINAL TANK. SIZE r�U�OOI 0^ <br /> TALAR HATER IAL,,// APPRDK. TANK AG1���. FILLSI7.E/TTFE /QOVERFILL CONTAINMEVTT TYPE <br /> AFI GRAVITY 344AT SI DF,G. F. - API cRAVITY OF J-rf 6OF • COEFFICIENT OF ERFANSION OF ,000 44.LZ 3 - COF 4 Z <br /> VISABLE VFNTING AFPREARS TO BE AT ILL END FILL OFOSITE END, BURP TITS HAS BALL <br /> -�CHECK, UNKNOWN, OTHER <br /> p� <br /> VISABLE VAPOR TRAPS TO BE BLED: BALL CHECKS, MANWATS, RETURN LINES, OTHER <br /> PHASE II VAPOR RECOVERY STSTEMs BALANCED, ASPIRATOR <br /> �ASSISTED. <br /> . LONG RUN WELLS. MANIFOLDED, gE, OTHER <br /> FUFH IMG SYSTEM: SUQCTION, MAKE 4� MODEL "PIPE LINE LEAK DETTORS TES,.(E>O7 AFPLiC <br /> CHARTED SIZE 9QS(�j EST. LINE QUANTITT /� PRODUCT ADDED TO FLOOD SYSTEM Jl <br /> Si3i@1 TORAL GALLONAGE ��IJO Z- <br /> AMBIENT CONDITIONSs iE1:Ps FRETESi FOSTEST � CLOUDY, RAINING, WINDY, BREEZT, NIGHT, OTHER <br /> .4 PSI DRO6f4vHOURS TEST TO START/,Zo�OROURS PSI TO BE MAINTAINED ONoTANK BOTTOM DURING TEST PERIOD ¢. 9 PSI <br /> A.'CRADE TO TARE BOTTOM _ w� <br /> B. GRATO TANK TOP `�� <br /> DE <br /> 6�irAE C. TANK DIAVET11R <br /> D. TPST LEVEL ABOVE GRADE l/ <br /> E. lXiERNAL CMtW MATER ABOVE TAN[ <br /> BOTTM IN. 1 .0361 PSI - <br /> 4J� F. TOP OF FILL TO POM. AT ARRIVAL <br /> A/ O G. TOP OF FILL TO TOP OF TANK /�-- <br /> 9 H. TMS LBVPL"TO BOTTOM OF TANK <br /> 3 r <br /> C • PSI PP.R INCII OF PRODUCT � z <br /> w� MATER 41 DE <br /> E TANK a -/ <br /> TEST HEIGHT FRESSIJRE FDR?A1LA <br /> J K l l _ E• P51 NFT 4, <br /> P <br /> REMARKS! <br /> RESULTS <br /> THE FINAL TEST PERIOD AS SHOWN ON THE ATTACHED COMPUTER GENERATED DATA REFLEC'T'S A <br /> OS / GAIN OF:��Qa' GALLONS PER HOUR, WITH A 99% CONFIDENCE LEVEL OF <br /> �1l <br /> THE HORNER EZY CHER II TEST METHOD COMPLIES WITH EPA AND THE STATE OF CALIFORNIA PERFORMANCE STANDARD OF 0.05 GPH <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 EQUAL TO OR GREATER THAN THE 0.05 GPH STANDARD. <br /> INTEGRITY TANK TESTING S VICES, 166 FRANK WEST CIRCLE, STOCKTON, CA., 95206, (209) 466-8036 of (800 2/62-8378 <br /> CERTIFIED TESTER STATE LICENSE A 10" to TEST DATE t Il1 <br />