Laserfiche WebLink
leiJ <br />12 TIME <br />(MILITARY) <br />DATA CHART <br />CONSTRUCTION ® A <br />BASK7 <br />5 TEST REQUESTED BY: I V ) JC !Ufn G /J —r,4 L 14 e,4f—! <br />Name - Position Order No. Billing Address <br />psi O kPa <br />CA Ur- #394-896 <br />., <br />CONCLUSIONS, REPAIRS AND COMMENTS <br />For Use With <br />C <br />/� <br />15-3q <br />/f y� f� ` <br />�I�Iy/�W �� / <br />OAKS,FW <br />7 CONTRACTOR OR COMPANY MAKING TEST <br />1 LOCATION: tJ e <br />l c r::: ! i 141 iJ W <br />c. <br />;. Ecc <br />E <br />— <br />Street No. ani/or Cotner <br />City state Telephone No. <br />Z <br />Z A4 <br />O ®1J 60 Ab <br />17 t <br />•D <br />2 OWNER: _ <br />Name <br />Address <br />Representative Position Telephone No. <br />> B <br />00Wa <br />3 OPERATOR:— <br />Name <br />May.. o/r Other - <br />Address <br />Address (ir different than Location) Telephone No. <br />/j <br />4 REASON FOR TEST _ <br />J g ypDealer, <br />® ) <br />,. <br />leiJ <br />12 TIME <br />(MILITARY) <br />13 LOG OF TEST PROCEDURES, <br />AMBIENT TEMPERATURE, <br />WEATHER, ETC. <br />so z <br />N L) <br />5 TEST REQUESTED BY: I V ) JC !Ufn G /J —r,4 L 14 e,4f—! <br />Name - Position Order No. Billing Address <br />psi O kPa <br />{z <br />3 <br />NET <br />CHANGE <br />CONCLUSIONS, REPAIRS AND COMMENTS <br />6 SPECIAL INSTRUCTIONS: <br />AFTER <br />C <br />/� <br />15-3q <br />/f y� f� ` <br />�I�Iy/�W �� / <br />7 CONTRACTOR OR COMPANY MAKING TEST <br />/. 0 <br />savEg <br />JUN 15 1988 <br />ENVIROMENTAL HEALTH <br />FERMIT/SERVICES <br />! l i 7 <br />MECHANIC(S) NAME <br />8 IS A TANK TEST TO BE ❑YES 8 MAKE AND TYPE OF <br />i <br />OF <br />rn <br />MADE WITH THIS LINE TEST? PUMP OR DISPENSERS <br />m <br />} <br />M <br />> B <br />00Wa <br />NO <br />10 WEATHER TEMPERATURE IN TANKS 'F <br />_ <br />o <br />COVER�`,r / APPROXIMATE <br />'C OVER LINES /,+'�' / 041' BURIAL DEPTH <br />Concrete. slack o. etc. <br />E <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 />15 VOLUME <br />16 TEST RESULTS <br />psi O kPa <br />READING <br />BEFORE AFTER/ <br />NET <br />CHANGE <br />CONCLUSIONS, REPAIRS AND COMMENTS <br />BEFORE <br />AFTER <br />L.� iJilil� <br />/� <br />15-3q <br />/f y� f� ` <br />�I�Iy/�W �� / <br />✓u� <br />/. 0 <br />savEg <br />JUN 15 1988 <br />ENVIROMENTAL HEALTH <br />FERMIT/SERVICES <br />! l i 7 <br />w -7_u9-F,/P9 L� <br />c Lx�G <br />0.�f <br />> D <br />I Y/ Cl <br />77— _1D <br />✓ G✓ <br />f f ® <br />✓✓tel e 9) <br />