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WORKSHEET FOR SUBMITTAL TO GOVERNMENTAL AGENCY <br />-00 011 <br />OTmER/OPERATOR /—!,',/j�/^/4JAee�+ SITE ADDRESS <br />CITY �'l�`�/ fo COUNTY <br />s <br />NAILING ADDRESS <br />SITE ACENT �®%�/� c�'c.><�c.�/—,yI TELEPHONE <br />ARRIVED TESTS HOURS TAM LOCATION jFrjd7- 7e-44.4< Z- PRODUCTy� ��� <br />DATE/TIHB STORAGE FILLED/06 J*-9qQ9cT LEVEL AT ARR111QAL'376CAES BELOW TOP OF FILL NOMINAL TANK SIZE ®CO® <br />TANK HATED X. TANK AGRI TRS. FILLSIZE/TYFEm-�_OVERFILL CONTAINMENTTTPE_ <br />API CRAVI i¢ AT -a DEG. F. - API GRAVITY o ,6 @ 60F COEFFICIENT OF EXPANSION OF .000 C.pp0%S . COE 6$/ <br />VISASLE VENTING APPREARS TO BE ATt FILL END, FILL OPOSITE END, RAS SURF PURE, HAS BALL CHECK, UNKNOWN, TREK <br />VISASLE VAPOR TRAPS TO BE BLED* ALL CRECKS NANWAYS, RETURN LINES, ITt TLS-��T%JT 6 19C� <br />PRASE II VAPOR RECOVERY SYSTENt C® ASPIRATOR ASSISTED. LONG RUN WELLS, NANIFOLDED. NONE, OTHER <br />PUMPING SYSTEM: SUCTION. Y HAKE 00'4.Q c ® MODEL PIPE LINE LEAK Detector TES NOO.NOTeAArPLYC <br />CHARTED SIZE OG0 EST. LINE QUANTITY PRODUCT ADDED TO FLOOD SYSTEM X SYG)'''STEM TORAL GALLONAGE Zd <br />AMBIENT CONDITIONSt TEMPI PRETEST 0 POSTEST BUNNY, CLOUDY. RAINING, WINDY, BREEZYNYCR% OTHER) �J <br />.4 PSI DRO ^HOURS TEST TO STAR OURS PSI TO BE MAINTAINED ON TANK BOTTOM TIMING TEST PERIOD Ile Q PSI <br />d4'e1PAE"' <br />.':lAq <br />REMARKS, <br />�2. ® ®GTrm LN. X .0361 PSL <br />P. TOP OF FILL TO PROD. AT ARRIVAL <br />A(® 0. TOP OF FILL TO TOP of TANK <br />0 -Ii .1 H. TES P:.IaVEG' Tb 'LN)T I09V Of TANK <br />PSL PER INCH of PRODUCT ®ZEa <br />R. GRADE TO TANK BOTI M <br />®. GRADE TO TANK TOP <br />ILE. <br />S7 <br />C. ?AMR DIAMETER <br />9¢ <br />0. TEST LEVEL ABOVE GRADE <br />-33' <br />EXTERNAL CROUND MATER ABOVE TANK <br />TEST "EIGHT ►RBSSURE POMILA <br />/— X a 4i, 80 <br />H._ PSL E. PSI NET PSI <br />RESULTS <br />�IE FINAL TEST PERIOD AS SHOWN ON THE ATTACIIED COMPUTER GENERATED DATA RrFI.rC'I'S A <br />OS / GAIN OF: -f-A-0GALLONSPER HOUR, WITH A 99% CONFIDENCE. LEVEL OF +/— p6o,?o Rph. <br />THE HORNER EZY CHEK II OD COMPLIES WITH EPA AND THE STATE OF CALIFORNIA PERFORMANCE STANDARD OF 0.05 GPH <br />FOR TANK INTE(SE ION 2643 CALIFORNIA CODE OF REGULATIONS) BASED UPON THIS STANDARD, THE RESULTS <br />SHOWN ABOVE: DOES NOT ICATE AN UNAUTHORIZED RELEASE EQUAL TO OR GREATER THAN THE 0.05 GPH STANDARD. <br />INTEGRITY TANK TESTING ERVICES, 41 WEST YOKUTS ST. STOCKTON, CA., 9``5207, (209) 474-1375 or (800) 2622-8 78 <br />CERTIFIED TESTER v STATE LICENSE 0_ �[ ) ® Z/3 TEST DATE ( (n- <br />/ 1" <br />