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FROMISERVICE-.STATION SERV 5. 11 . 1589 _ P. <br /> • I1FI1�'gr!`,'t3�, ©9 LSE: T.yIRNGLE INCORPCIRATED P'` �A r77 <br /> I� �! r Data Chart for Tank System Tightness Test <br /> PLEASe-P111N7 <br /> 1. OWNER rrep.,ty❑ �-- <br /> T001❑ N recta —_ ._ . .�• _ RaDro>enUgW 7aiaphane <br /> NIM Addrew Fep(eontallve Telephone <br /> 2. OPERATOR Y`9_'L_) <br /> Name Azaleas T$IOphQM <br /> 3. REASON FOR .– <br /> TEST <br /> (explain Putty) - <br /> 4. WHO REOUESTED <br /> TEST AND WHEN (ane Title Gampany or Affiliation Oster <br /> _.. Ad4ra$ --..— TOI6Dhone <br /> Idoellty eY olfaction Capaau Or•ndrSup Ilex Oraoa Aporoe.Ape St I/PIbe,01aM <br /> 5. TANK INVOLVED <br /> 1�1�7�C <br /> UN additional unea —— <br /> tat malnitolded lanxt -- <br /> Laallon Cover 0111 vents `iphOtrea Pumps <br /> B• INSTALLATION ppw©G <br /> DATA <br /> 6 nal a drlvowpy. CSonotHa.stick TOR Die*,71tooll m•4e,Orvp alio(on,Rol,bl•. <br /> Phar of wtlon,alo Barth,etc. Wbe$,Komete I'Me Rize.Manl(otded YM14M links? Mako It known <br /> 7. UNDERGROUNDt6 the wall?over the link? <br /> WATER Depth to lho Wailer 16014 ❑r« <br /> S. FILL-UP Tank$to be tilted nr. Oa1s Ateanpad by T Noma Tolephons <br /> ARRANGEMCNTS Jxtts product to'fop elf'Ino fun link 1a61ar. HOw j6d who to provide? Daneloar NQ Load. <br /> Termin•1 or alhor aont•Ot <br /> Ipr notice or InOulry Nome TatsphOno <br /> Gpmp•ny <br /> 9. CONTRACTOR, -- <br /> MECHANICS, — ----- <br /> any What 01`10111091 <br /> InYPlwd "�10. OTHER <br /> OTHER -�-�-- - — <br /> INFORMATION �- <br /> OR REMARKS — <br /> Addhbnsl tnlornuUon on any llama aeove.Olrielply or o+heu m be aalr.d when IPPrnp la In propraae of eomplm.d.vlaitan or oworvon ptuent dunnp twt,eca. <br /> Tleala Woro made on the abovt lank leyleleme in ACCAfdsinft Wtth test MCOdurW Presicflt»d lot <br /> 11, TEST RESULTS u 0"aid an tRtaatrtd test china Wltn ruut tmrac <br /> Tank Idenli4stion T1ah1 Look / bete Tooted <br /> Cv r <br /> 12, SENSOR 13,rnb is to ON""m OWO#tank systems ware luted an Vale d shown Ind{aleta!p-NW MOM lir wltle$ta TletablElhled W d" <br /> CERTIFICATION N~AJ take pmoecWn rpoodon Ralmnt W 920. <br /> I <br /> 1. "Hine contraoler or GomDsny. By: ltpnature <br /> soon w 0 Tbumel GAIhM11sn a , <br /> ean6or , <br /> P, 0.BOX 9795 <br />