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x <br /> WORKSHEET FOR SUBMITTAL TO GOVERNMENTAL AGE-,,ICY <br /> OWNER/OPERATOR �%kiv� I�/'C/ <br /> -. r--�� 'L.-��/_- SITE ADDRESS <br /> CLTT �'7~�-•��_�' `� COUNTY <br /> HAILING ADDRESS <br /> SITE ACETTf TELEPHONE <br /> ARRIVED TEST SII �HOtR_'� TANK LOCATION PRODUCT <br /> DATE/TIME STORAGE FILLED% ­/�llr'pRODUCT LEVEL AT ARRIVAL <br /> TALAR MATERIAL Z <br /> INCHES BQW TOP OF FILL NOMINAL TANK SIZE <br /> �,�"' ^� <br /> Ls .�' APPROX. TANK AGETRS. FILLSIZE/TYPEEL � CVERFILL CONTAIDMMrr TYPE <br /> API GRAVITC111•';7 AT DEC. F. - API GRAVITY OF-3U.1 P 60F CC EFFICIENT OF EXPANSION OF .000 �;7 <br /> li CI - COE ~J <br /> VISABLE VENTING APPREARS TO BE AT: FILL END, FILL OPOSITE END, RAS BURP TUBE, RAS BALL CHECK, UNKNOWN, OTHm <br /> VISABLE VAPOR TRAPS TO BE BLED: BALL CHECKS, MANWAYS, RETURN LINES, OTHER /�^►-✓/Gf ��" <br /> PRASE II VAPOR RECOVERY STSTEM: BALANCED, ASPIRATOR ASSISTED. LONG RUN WELLSHANIFOLDEDNONE, <br /> , , l OTHER <br /> PUMPITNC SYSTEM: SUCTIOI . (TURBINE 'HAKE �//��i`�THODEL `�¢ \_J <br /> PIPE LINE LEAK.DeteCtO TES, LA0; NOT APPLIC <br /> CHARTED SIZE /Z��U EST. LIRE QIIANTITT S PRODUCT ADDED m FIAOD SYSTEM S STSTEH TORAL GALLONAGE <br /> AMBIENT CONDITIONS: TF?iP: PRETESTTEST SUNNY, CLOUDY, RAINING, WINDY, BREEZY, NICHT, OTHER <br /> POSf �zJ <br /> 4 PSIDR I,5 HOURS TEST TO START //'HOURS PSI TO BE MAINTAINED ON TANK BOTTOM DURING TEST PERIOD .'i C� <br /> ? PSI <br /> A. GRADE TO TA NX BOTTOM ;J <br /> T 1. GRADE TO TANK 70P U�/ <br /> C. TANK DIAMETER <br /> 6.Pi9AE _ � <br /> � <br /> �- � /► D. TEST LEVEL ABOVE GRADE —'T <br /> E. EXTERNAL GROUND MATER ABOVE TANK <br /> IOTTOH IH, I .0361 PSI - <br /> F. TOP OF FILL TO PROD. AT ARRIVAL <br /> C. TOP OF FILL TO TOP OF TANK <br /> JQ�A N. TEST:.IB9EL'.7070TTOH OF TANK <br /> C PSI PER INOI OF PRODUCT �le <br /> MATER :�TNK •. / TEST HEIC+iT PRESSURE FORMICA <br /> REIARKS' H. PSI E. PSI NET PSI <br /> RESULTS <br /> ,_-,----)THE FINAL TEST PERIOD AS SHOWN ON THE ATTACHED COMPUTER GENERATED DATA REFI. CTS A <br /> LOSS / GAIN OF✓�� GALLONS PER HOUR, WITH A 99% CONFIDENCE LEVEL OF +/- __�L^� <br /> gph. <br /> THE HORNER EZY CHEK-11I SXrV 8 COMPLIES WITH EPA AND THE STATE OF CALIFORNIA PERFORMANCE STANDARD OF 0.05 CPH <br /> FOR TANK INTEG� // TF.aTING. (IBECTION 2643 CALIFORNIA CODE OF REGULATIONS) BASED UPON THIS STANDARD THE RESULT <br /> SHOWN ABOVE: I) 9.-'DOES NOT INDICATE AN UNAUTHORIZED RELEASE EQUAL TO OR GREATER THAN THE 0.05 CPH STANDARD. <br /> INTEGRITY TANK TEG ICEdSkui , P.O.BOX 691376 STOCKTON, CALIFORNIA, 95269 (209) 474_1375 or ( 0) P62-8378 <br /> CERTIFIED TESTER _ I J /( •ISTATE LICENSE 0 l% �'i� ✓w <br /> —� TEST DATE � � <br />