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pp� <br />t–�AlF1TP I�/[®MS .[ •7C° <br />I <br />ICE <br />N.rrle Adlre.s Zip Mpreeenl.pw T.Npl,.rle <br />2. OPERATOR <br />& c <br />.wme <br />S <br />4; LF <br />s ' <br />i <br />� • i <br />��js;3 L 3 <br />yr( <br />- <br />4 <br />ns 1:,l <br />Nen" T.N CdngM or <br />a <br />e <br />Reeq <br />(� <br />3 <br />So <br />=Fe <br />i <br />_ <br />—.----.-. <br />3 <br />3 <br />�l <br />� <br />Llpn-Ma <br />10 / e► zm�P <br />Suctnn. Remole <br />MW t«Ma1 MMa a Xnown <br />7. UNDERGROUND <br />WATER <br />G.pnma»r .g. mmg.g. tie�OlU 167` !Dell - <br />•tn..««^•«t^^t.nX' <br />❑l <br />8. FILL -UP <br />ARRANGEMENTS <br />T.nha to Ee Igmg Prov M —a --13 Dele All.,,. I �. <br />tl.me <br />—.1 <br />«g+aNG e.a <br />r <br />T«mmol or dMr conlacl <br />Id roMa or l,ry <br />a <br />OOb 9 <br />m <br />_— <br />Wme Teiapnone <br />� o <br />� <br />-- <br />pp� <br />t–�AlF1TP I�/[®MS .[ •7C° <br />Z 1lepreeen4uw TeNpndr <br />Z* cy W, K�)r i,, Ot.t P.4. <br />N.rrle Adlre.s Zip Mpreeenl.pw T.Npl,.rle <br />2. OPERATOR <br />& c <br />.wme <br />K 3. <br />�( D <br />Agdpe Z. <br />— <br />T.Mpnom <br />3. REASON FOR <br />TEST <br />(EApli Fully) <br />Gt <br />- <br />4. WHO REGUESTED <br />TEST AND WHEN <br />ns 1:,l <br />Nen" T.N CdngM or <br />a <br />e <br />q <br />o <br />5. TANK INVOLVOU <br />IJa alldLbnal llriea <br />for maMblad tanks <br />�7 •tN h <br />L p <br />_ <br />—.----.-. <br />3 <br />3 <br />6. INSTALLATION <br />DATA <br />� <br />Llpn-Ma <br />10 / e► zm�P <br />Suctnn. Remole <br />MW t«Ma1 MMa a Xnown <br />7. UNDERGROUND <br />WATER <br />G.pnma»r .g. mmg.g. tie�OlU 167` !Dell - <br />•tn..««^•«t^^t.nX' <br />❑l <br />8. FILL -UP <br />ARRANGEMENTS <br />T.nha to Ee Igmg Prov M —a --13 Dele All.,,. I �. <br />tl.me <br />—.1 <br />«g+aNG e.a <br />r <br />T«mmol or dMr conlacl <br />Id roMa or l,ry <br />a <br />OOb 9 <br />m <br />_— <br />Wme Teiapnone <br />� o <br />� <br />-- <br />3 <br />a <br />Q o <br />T <br />H <br />D <br />L <br />T <br />� s Com- _k � <br />AFFORDA-TEST <br />POB 36 <br />THORNTON,CA.95686 <br />Data Chart for Tank System Tightness Test <br />PLEASE PRINT <br />1. OWNER Ropwh❑ <br />TmXlal ��� <br />t–�AlF1TP I�/[®MS .[ •7C° <br />Z 1lepreeen4uw TeNpndr <br />Z* cy W, K�)r i,, Ot.t P.4. <br />N.rrle Adlre.s Zip Mpreeenl.pw T.Npl,.rle <br />2. OPERATOR <br />& c <br />.wme <br />Agdpe Z. <br />— <br />T.Mpnom <br />3. REASON FOR <br />TEST <br />(EApli Fully) <br />Gt <br />- <br />4. WHO REGUESTED <br />TEST AND WHEN <br />ns 1:,l <br />Nen" T.N CdngM or <br />a <br />Aeti A <br />AOonea zlp <br />genllh ev Gnwan cepwty er.=a.SuwXer Grove <br />I <br />Tel.pM <br />Approa. Age y«Y,Fre« <br />5. TANK INVOLVOU <br />IJa alldLbnal llriea <br />for maMblad tanks <br />�7 •tN h <br />_ <br />—.----.-. <br />6. INSTALLATION <br />DATA <br />Leutan Carer L,,, Fula /a , <br />�,C <br />�p� �Y� p� CO�#er%) y <br />Yb K <br />Nprin intl0o dIrMSY- Com:m.. II -X T. S..' Tnelie melee Oro- <br />R.vr M ««pn, etc ENA. «c lugm. Femora Filo Sie. XYmlogeE <br />Llpn-Ma <br />10 / e► zm�P <br />Suctnn. Remole <br />MW t«Ma1 MMa a Xnown <br />7. UNDERGROUND <br />WATER <br />G.pnma»r .g. mmg.g. tie�OlU 167` !Dell - <br />•tn..««^•«t^^t.nX' <br />❑l <br />8. FILL -UP <br />ARRANGEMENTS <br />T.nha to Ee Igmg Prov M —a --13 Dele All.,,. I �. <br />tl.me <br />—.1 <br />«g+aNG e.a <br />r <br />T«mmol or dMr conlacl <br />Id roMa or l,ry <br />CdnpenY <br />_— <br />Wme Teiapnone <br />9. CONTRACTOR, <br />MECHANICS, <br />wy w"r <br />m Iwa <br />-- <br />10. OTHER <br />INFORMATION <br />OR REMARKS <br />AgEXpnal color erm .Core. GIXowT « dMre tp leslnq 5 m progrpe compMeg. <br />Vroitore or poasrvere proem goring teat. e <br />11. TEST METHOD <br />PETRO TITE <br />❑ PETRO COMP <br />❑ OUICK CHECK 2000 <br />l a. TEST RESULTS <br />Tab wen mwe w du aeow talc epow h acca.daoa wNh MEI Olacaaaaa pees b d I.,i <br />a dela" W attae+ed Met euro with neeb a follows: <br />T.nX lgentlt�tmn Tlgm WW Clu,p p.r !bur 0«e Taal.a <br />Ye — — <br />12. SENSOR <br />CERTIFICATION <br />6—p--9/ <br />13. CONTRACTOR CERTIFICATION AFFORDA TEST <br />POB +36 <br />Twp.�.n THORNTON,CA.95686 <br />-ens* ft 2 Twwv carwwd d cdeg.oyBy swn <br />c.nnlvppn . <br />Gtle <br />S3/ <br />s«I.I Xo. of TMrm« <br />i <br />p 27 <br />