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TANK FILL DATE: IME:tboo <br />TANK TEST DATE: TART: END: 095b LENGTH OF TEST: <br />TANK BOTTOM TO GRADE.... TEST LEVEL TO TANK BOTTOM <br />TANK TOP TO GRADE......V"40- GROUND WATER ABOVE TANK.. ` <br />DIAMETER— .... ..1—o ...0 � PSI.....# ................ <br />TEST LEVEL ABOVE GROUND._ NET TEST PRESSURE,........ <br />WATER IN TANK..........API SPEC GRAV...........,� <br />DEPTH FOR TAKING SAMPLE. � TEMP .................... J <br />TEMPERATURE PROBE DEPTH. -I API SPEC GRAY @ 60' F.... <br />COEFICIENT OF EXP........ <br />CERTIFIED TIGHT --YES(/) NO( ) <br />PRODUCT LINE TEST --PASS FAIL(-) <br />CERTIFIED TIGHT --YES( ) NO( ) <br />COMMENTS: <br />LEAK RATE PER/FIR:+ <br />SUCTION( ) PRESSURE'S) <br />LEAK RA'Z'E PER/HR:+ /- <br />DATE: SIGNATURE OF TESTER:� <br />REV 3/92 <br />J <br />'Crisp Tank ftfing& Constru on Corn tiny <br />Phone (204) 431-1928 Licensed <br />Post Office Box 30487 insured <br />Stocldon, California 45213 d <br />**TEST REPORT** <br />OWNER OF SITE: yn <br />_ <br />ADDRESS: _.3_ _CITY: �_. 'LIP <br />OWNER OF TANKS:c� in P <br />ADDRESS: CITY: -I—ZIP: <br />OPERATOR AT LOCATION: Z-- rg h�,� <br />ADDRESS: a Z'2 6,tl CITY: ah /ecd7 ZIP: <br />COUNTY- TANK #: AGE: GALLONS: 11� <br />v <br />Al <br />'LE WALLED ) <br />METAL (} FIBERGLASS( ) SINGLE ( DOUBLE WALLED( ) <br />DIESEL( UNLEADED( ) PREMIUM UNLEADED( ) ( ) <br />WASTE OIL( ) KEROSENE( ) AVIATION GAS( ) JET FUEL( ) WATER( ) <br />SUCTION( ) SUBMERSIBLE(V4 OVERSPILL CONTAINER --YES( ) NO(V) <br />SHEAR'?VALVE--YES(\t) NO( ) IN-LINE LEAK DETECTOR --YES( ) NO(K) <br />VAPOR RECOVERY SYSTEM--YESO 'NO( ) *IF YES, PHASE I( ) PHASE 2( ) <br />TANK FILL DATE: IME:tboo <br />TANK TEST DATE: TART: END: 095b LENGTH OF TEST: <br />TANK BOTTOM TO GRADE.... TEST LEVEL TO TANK BOTTOM <br />TANK TOP TO GRADE......V"40- GROUND WATER ABOVE TANK.. ` <br />DIAMETER— .... ..1—o ...0 � PSI.....# ................ <br />TEST LEVEL ABOVE GROUND._ NET TEST PRESSURE,........ <br />WATER IN TANK..........API SPEC GRAV...........,� <br />DEPTH FOR TAKING SAMPLE. � TEMP .................... J <br />TEMPERATURE PROBE DEPTH. -I API SPEC GRAY @ 60' F.... <br />COEFICIENT OF EXP........ <br />CERTIFIED TIGHT --YES(/) NO( ) <br />PRODUCT LINE TEST --PASS FAIL(-) <br />CERTIFIED TIGHT --YES( ) NO( ) <br />COMMENTS: <br />LEAK RATE PER/FIR:+ <br />SUCTION( ) PRESSURE'S) <br />LEAK RA'Z'E PER/HR:+ /- <br />DATE: SIGNATURE OF TESTER:� <br />REV 3/92 <br />J <br />