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AUVUKUA <br />TEST <br />POO 436 DATA CHART <br />THORNTON,CA. 95686 For Use With <br />T& p f� <br />1 LOCATION • y zwwj� /, w 0 /v <br />Sheet o. and/or Corner City S e Telephone No. <br />2 OWNER: %O I(U T 104G I <br />�}� Nem. Add—, Rep...enlelive Position Telephone No. <br />3 OPERATOR:.,(c�7%mCs' <br />N Dealer, Mor. or Orher Address (1AL f1 dlllerenl IMn Loeatlon) T.I.Phon. No. <br />4 REASON FOR TEST_ 7 � � <br />r <br />12 TIME <br />(MILITARY) <br />13 LOG OF TEST PROCEDURES, <br />AMBIENT TEMPERATURE, <br />WEATHER, ETC. <br />i <br />G <br />S TEST REOVESTED BY: itad <br />s�—� Position Order No. BIRIr+Y Addre.f <br />NET <br />CHANGE <br />CONCLUSIONS, REPAIRS AND COMMENTS <br />BEFORE <br />AFTER <br />9 SPECIAL INSTRUCTIONS: <br />"e0 M %9le <br />- <br />4/ +..: T�fi✓ <br />7 CONTRACTOR OR COMPANY MAKING TEST <br />wa <br />MECHANIC(S) NAME <br />AND TYPE Of <br />o' <br />O <br />v~i <br />9 IS A TANK TEST TO BE <br />MADE WITH THIS LINE TESTI <br />YES <br />9 MAKE j8• i> i A i%% —_ <br />PUMP OR DISPENSERS —+Z�s�/' it <br />> Q <br />on O <br />❑ NO <br />COVER APPROXIMATE ®'1y <br />'F 'C l'7 j� �' BURIAL DEPTH <br />10 WEATHER <br />TEMPERATURE IN <br />TANKS _ OVER LINES -- <br />Connate, Black Top. etc. <br />11 IDENTIFY <br />EACH LINE. <br />AS TESTED <br />12 TIME <br />(MILITARY) <br />13 LOG OF TEST PROCEDURES, <br />AMBIENT TEMPERATURE, <br />WEATHER, ETC. <br />14 PRESSURE <br />16 VOLUME <br />16 TEST RESULTS <br />psi OR kPa <br />READING <br />BEFORE AFTER <br />NET <br />CHANGE <br />CONCLUSIONS, REPAIRS AND COMMENTS <br />BEFORE <br />AFTER <br />"e0 M %9le <br />- <br />4/ +..: T�fi✓ <br />wa <br />!0®G/d7 <br />�A� <br />- <br />/� <br />v <br />�G <br />LL <br />— — <br />i <br />/ <br />.r <br />41c?' <br />60 <br />114i� <br />110 <br />...a <br />e <br />/ <br />R'1 <br />G/ <br />62) <br />b <br />--f <br />7 <br />L <br />Name <br />= <br />Liceme <br />