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Data Chart for Tank System Tightness Test. <br /> peifro Tite <br /> PLEASE PRINT 02P ITANK TESTER <br /> 1. OWNER ProGrty IIXI 7- G Y G .` <br /> �` N yty� dens y� •ai•.•nuli+�. T.aoeon. <br /> Tank(s) �5�1 W'M ��� � /7'///��I� ��4drus i �/s �} Rrous.nuuw T.1•anaw. <br /> 2. OPERATOR <br /> Name Address <br /> 3. REASON FOR- <br /> TEST <br /> (Esplsin Fully) <br /> 4. WHO REQUESTED �'� �7� <br /> TEST AND WHEN Nsm. title i " Camoany a Attilladon Due <br /> Address T.taphene <br /> 5. WHO IS PAYING ' <br /> FOR THIS TEST? company.Agency or Indwdaat Person Audre'wr4 Time Tsi.onon. <br /> serine Address i City State - Zip <br /> Allamian GO: Ord•r No. Oth.f Inslruttions <br /> Identify by Direction Capacity Brand/SupDlkr Grid. ApiXt]:,Ago Steel/Fiberglass <br /> 6. TANK(S) INVOLVED <br /> SA <br /> 4 ?H t x.44 U it# <br /> Location IV14. Caw Fill Vents Siphons$ Pumps <br /> 7. INSTALLATION <br /> DATA.. : fito a'VZ4-E7- <br /> NerM Y+sidmill pow. Connie Black Tag. S4%Thelia pieke,Oreo <br /> Suction Remate. <br /> Rear of.utloR*M Gra),eta, lu"&-Ram01.Fema $ite.Menilaleed Whkh lanks F Make it lnawn <br /> 8. <br /> UNDERGROUND / Is the water over the tank? <br /> WATER Depth to the water table /7 <br /> 0 yes Moo <br /> 9. FILL-UP Tanis to i»filled Date Arringed by <br /> !t <br /> ARRANGEMENTS Extra product to- p all and run TETT. Now and who to Provide 1 Consider NO Lsad. <br /> Terminal or othar contact $ <br /> for notice or Inquiry <br /> Company Nam. <br /> Telapnone <br /> 10. CONTRACTOR, <br /> MECHANICS. <br /> any other contractor <br /> involved <br /> 11. OTHER <br /> INFORMATION <br /> DA REMARKS E: <br /> Additional amnion an any hems above.011itials of others to be adv8ad when[.stin <br /> during ast.ea. g is in Progreso at compleobserversd.Visitors a<observersm preaa <br /> Tuts weft made on the ebaw tank systems in accordance with test Proaadures prescribed for ATO 1?! <br /> 12. TEST RESULTS as dstalted on atlached test charts with results as follows: T <br /> T8nk Identificationi <br /> Tight Leakage Indicated Dau Tested <br /> p Vo —ro 2 <br /> T; 3 <br /> S —41 Qi oc,> i <br /> 13. CERTIFICATION This Is to ciptimi IfyFh that that tank"a GMS were tested on!h�wte{aJ shower Thereat Indicaled as"Tight'meet the wtleria established by <br /> the Natrona)Fire Protttcllan Asoelattan Pamphlet 729. <br /> oat. 1� S L r-ence Tank Testing , <br /> P.O. Box 407 gh.evr. <br /> Serum N° a""m'a Down'leville.Callfomia9593fi (916) 289-3109 <br /> Sensgl eC ns .. <br />