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f - <br />WORKSHEET FOR SUBMITTAL TO GOVERNMENTAL AGENCY <br />OWNER/OPERATOR F� SITE ADDRESS e) //. <br />e7T^1 <br />CITY T COUNTY t,T® Q &//, j <br />HAILINC ADDRESS <br />SITE AGENT _ :N71 AAb G� ICii`Iu%TELEPHONE ( 9Q i1 4 <br />ARRIVED TEST SY 'P`SHOURS TAMC CATION <br />DATE/TINE STORAGE FIL '20t ` ff4CT LEVEL AT ARRIVAT -© INCHES BELOW TOP OF FILL NOH2NAL TANK SIZE A'-600 <br />TANK MATERIAL APPROK. TANK ACF Qr7 RS. FILLSIZE/TYPE 7' OVERFILL CONTAINMENT TYPE ass ��, <br />API CRAVITT�4rS AT V DEC. F. - API GRAVITY OF S Te r C 6OF - COEFFICIENT OF ExPANSiON OF .000 AOMS 3 - COE <br />VISABLE VENTING APPREARS TO DE ATt FILL END, FIit. OPOSITE END, HAS BURP TUBE, RAS FALL CHECK, TOWN, THF.R <br />VISABLE VAPOR TRAPS TO BE BLEDs CHE HANWAYS, RETURN LINES, TL -S 2.4 <br />PHASE 12 VAPOR RECOVEM STSTEM: C ASPIRATOR ASSIST®, LONC RUN WELLS, HANIFOLDED, ROME, OTHER <br />PUMPING SYSTEM? SUCTION, dEiNE MAKE 0Q1 O MODEL PIPELINE LEAK Detecto S. N0; NOT "PLIC <br />CHARTED SIZE EST. LINEQtlANTITT PRODUCT ADDED TO FLOOD SYSTEM .�7 tS73TEH TORAL CALLONAGE <br />-s�S <br />AMBIENT CONDIIIONS: TEMPI PRETEST J �P��O99STTES7 SUMI, CLOUDY. RAINING, WINDY, BREEZY, ICHi OTRER <br />.& FSI D pHOtlRS TEST TO 37AR "-R PSI TO SE MAINTAINED ON TANK BOTTOM DURINC TEST PERI®D ® P32 <br />.s'i1 AE' <br />MATER <br />TANK . <br />HHARKS ., <br />A. CRAM TO TANK 10TIOM <br />lO 1. CMDF TO TANK TOP <br />C. TANK DIAMETER <br />D. TEST LEVEL ABOVE CRAVE <br />TL -3 e So <br />At <br />'14-1 <br />E. EXTERNAL CWUM MATER ABOVE TANK <br />1OtTOH TN. K .0361 Psi . <br />F. TOP OF FILL TO PROD. AT ARRIVAL <br />C. TOP OF FILL TO TOP OF TANK <br />.� <br />H. TEST:. sm-TQ',OTTOH OF TANK <br />PSI PER INCH OF PROMCI <br />TEST HEIGHT PRESSURE POWILA <br />/- K t: 469 <br />H. PSD PS1 NET PSI <br />RESULTS <br />TI , L AL TE PEyR I�on AS SHOWN ON THE ATTACHED COMPUTER GENERATED DATA Rrrl,rC•I'S A <br />LOSS GAI OF: #00t-'llALLONS PER HOUR, WITH A 99% CONFIDENCE. LEVEL, OF +/-000 tzrh. <br />THE HORNER EZY CHEK I METHOD COMPLIES WITH EPA AND THE STATE OF CALIFORNIA PERFORMANCE STANDARD OF 0.05 GPH <br />FOR TANK INTEG S NG. (SECTION 2643 CALIFORNIA CODE OF REGULATIONS) BASED UPON THIS STANDARD, THE RESULTS <br />SHOWN ABOVE: ES N INDICATE AN UNAUTHORIZED RELEASE EQUAL TO OR GREATER THAN THE 0.05 GPH STANDARD. <br />INTEGRITY TANK TESTING RVICES, 41 WEST YOKUTS ST. STOCKTON. CA.,,, 952/07, (209) 474-1375 or (800) 262-Q378' <br />CERTIFIED TESTER STATE LICENSE # `7d '`! ®�� TEST DATE l l ° z` <br />