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WORKSHEET FOR SUBMITTAL TO GOVERNMENTAL AGENCY <br /> Ot.'NER/OPERATOR S T.C.�J �'�/ ; c,c-; .�`sr <br /> SI7E ADDRESS <br /> CI7T — <'"' - ti�J COUNTY <br /> MAILING ADDRESS ��- <br /> SITE ACENT TELEPHONE <br /> r <br /> ARRIVED TEST SITV /5 ROURS TANK LOCATION /Vi IV PRODUCT % L',14 f U <br /> DATE/TIME STORAGE FILLEiy�_f PRODUCT LEM AT ARRIVAL 4 INCHES Bn= TOP OF FILL NOMINAL TANK SIZE ` `�= <br /> TANK MATERIALS� / APPROR. TANK Ac;i/ `/TRS. FILLSIZE/TYPE `` OVERFILL CONTAINMENT TYPE-_ �j�L�� <br /> API GRAVITTs`'"v AT S,S DEC. F. - API GRAVITY OFZi.Z-Q 60F - COEFFICIENT OF EXPANSION OF .000 J QSa - COE <br /> VISABLE VENTING APPREARS TO BE AT; FILL END, FILL OPOSITE MMN HAS BURP TUBE, HAS BALL CHECK, UNKNOWN, OTHFR <br /> VISABLE VAPOR TRAPS TO BE BLED: BALL--CHECK`S, HANWATS, RETURN LINES, OTHER TG �7Gl�A <br /> PHASE II VAPOR RECOVERY SYSTEM: ALANCED, 1 \\ pIRATOR ASSISTED, LONG RUN i7EIL$, HANIFOLDID, NONE, OTHER <br /> �� —� <br /> PUMPING SYSTEM: SUCTION, 1TURBINE� MAXE A) MODEL -7`?%PE LINE LEAK Detectors YES, N T APPLIC <br /> CHARTED SIZE le'5l LO EST.. LINE QDANIITy /& PRODUCT ADDED TO FLOOD SYSTEM <br /> iORAL GALLONAGE L� <br /> !2L .fid <br /> AMBIENT CONDITIONS: TEMP: PRETESTS POSI'EST� �SUNNY, OVDY, RAINING, WINDY, BREEZY, NICHT, OTHER <br /> .6 PSI DRO1/4k---HOURS TEST SO STAR'Ild0HOURS PSI TO BE MAINTAINED ON TANK BOTTOM DURING TEST PERIOD /U PSI <br /> A. GRADE TO TANK BOTTOM I <br /> 4 <br /> • O �� B. GRADE TO TANK TOP p / <br /> C. TAN[ DIA%MTER <br /> 6.c°i9AE <br /> D. TEST LEVEL ABOVE GRADE <br /> E. E7CTEil1tAL CRDLHD MATER ABOVE TJWC <br /> G F— _ L' /s BOTTCFI IN. z .0361 PSI <br /> F. TOP OF FILL TO PXOO. AT ARRIVAL <br /> A G. TOP OF FILL TO TOP OF TANK <br /> H. TL4'T:.IBPEL'TO'IOTTCM OF TANK <br /> i <br /> MATER I IDE C PSI PER INCH OF PRODUCT <br /> E TANK TEST HEIGHT PRESSURE FORMULA <br /> REPIIIRKS H. PSI E. PSI NET PSI <br /> RESULTS <br /> THE FINAL TEST PERIOD AS SHOWN ON THE ATTACHED COMPUTER GENERATED DATA REFLECTS A <br /> 'LO / GAIN OF:,,,-!' / GALLONS PER HOUR, WITH A 99% CONFIDENCE LEVEL OF gph. <br /> THE HORNER EZY CHEK II,*ETKD COMPLIES WITH EPA AND THE STATE OF CALIFORNIA PERFORMANCE STANDARD OF 0.05 CPS <br /> FOR TANK INTEGRII X TE,S2ING. (SECTION 2643 CALIFORNIA CODE OF REGULATIONS) BASED UPON THIS STANDARD THE RESULT <br /> SHOWN ABOVE: J}O.ES DOES NOT INDICATE AN UNAUTHORIZED RELEASE EQUAL TO OR GREATER THAN THE 0.05 GPH STANDARD. <br /> INTEGRITY TANK TEST t /NCc.31tRVICES, P.O.BOX 6913T6 STOCKTON, CALIFORNIA, 95269 (209) 4T4-13T5 or ( 0) U262-83T8 <br /> CERTIFIED TESTER (� I�w21 <br /> 7 1 STATE LICENSE Y TEST DATE <br />