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WORKSHEET FOR SUBMITTAL TO GOVERNMENTAL AGENCY <br />„rr�� <br />ocaNER/oPERArOR �44�l1it�S ���� strE ADDRESS <br />CITY r <br />NAILING ADDRESS <br />_ TELEPHONE PWI <br />ARRIVED TEST SI HOURS LOCATION <br />DATE/TINE STORAGE FILL PRODUCT LEVEL ATAARRRIVAL <br />TANK MATERIAL APPROX. TANK AGL55* TRS. <br />API GRAVITY -97-f d <br />"MCHES FELON /STOP OF FILL LR1NtNAL TANK SIZE_ <br />c FILLSIZE/Y1PE 4 OVERFILL. CONIAtMr"j TYPE f t�,(/19►�,.G <br />• AT DEC. F. - API CRAVITT OFA' 7 160F - COEFFICIENT OF E 110gION OF ,0W0 ,--4f - COP <br />VISARLE VENtINC APPRURS TO EE ATt FILL END, FILL OPOSITE END, HAS SURF TUBE, HAS SALL�^CHECK, , TNRR <br />VISABLE VAPOR TRAPS TO BE ®LEDs ALL CHECKS, t1ANWATS, RETURN LINES, OTHER <br />PRASE II VAPOR RECOVERT BISTE"t ED ASPIRATOR ASSISTED, LONG RUN WELt.S, HANIFOLDED <br />• PM, OTHER <br />PInIPrNc SISTER? svcTloR, t tUUtE_ c�/G/rji4�2�G� �---' <br />MODEL PIPE LINE LEAR Detector WO; ROT APPLtC <br />CHARTED SIZE SOM EST. LIKE QUANTITY PRODUCT ADDED TO FLOOD SISTER SISTER TORAL CALLONACE2 Ga <br />AMBIENT C01M,ITIONSt iEltPt'PREIEST4POSTEST SUNRT, CLOVOT, RAINING, wtNDY, SREPZY, "tent, OTHER <br />.4 PSI DROI+040 HOURS TEST TO 9TAR$80nuURS PSt TO st MAINTAINED ON TANK EOTTOM D <br />URINC Pst <br />REMARKS 2EST FERIOD To <br />R. GRADE TO tARR So” <br />Qo <br />S/ <br />S. ORAD! TO TARR TOP <br />. v <br />C. TARR DIAUETER <br />D. TEST LIVIL AM Mot <br />E. M41MAL CRD W RATER ABOVE TALAR <br />? SOTTM iR. R .0361 PSI • <br />/ <br />17'51 <br />M y R. TOP OR FILL TO P000. AT ARRIVAL <br />! <br />C. TOP OF PILL TO TOP OF TARR <br />H. TESt".Letlt-* SOTTW OP mt <br />17 <br />PSI PER tom OP PADDUCP <br />v ''^•'-`—�� TEST ift t01l1S11.A � <br />psi <br />,e• JP -;r sv,40.e v <br />RESULTS <br />11E FINAL 'PEST P ;RIOD AS SHOWN ON 'Tim ATTACHED COMPUTER GENERATED DATA REFLECTS A <br />.OS / GAIN OFt," QLb GALLONS PER HOUR, WIT11 A 99% CONFIDENCE LEVEL OF +/- j! 01 gph. <br />111E HORNER EZY CHEK II TLkS&4VQTHOD COMPLIES WITH EPA AND THE STATE OF CALIFORNIA PERFORMANCE STANDARD OF O.os GPH <br />FOR TANK INTEW TE NG. (S CTION 2643 CALIFORNIA CODE OF REGULATIONS) EASED UPON THIS STANDARD, THE RESULTS <br />SHOWN ABOVE., ES NOT INDICATE AN UNAUTHORIZED RELEASE EQUAL TO OR GREATER THAN THE 0.05 GPH STANDARD. <br />INTEGRITY TANK T TING VICES, 166 FRANK WEST CIRCLE, STOCKTON, CA., 95206, (209) 466-8036 or (80 262 8318 <br />CERTIFIED TESTER STATE LICENSE / •�lQ�/_ TEST DATE �% <br />