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WISP T/�UK TESTING (0_x CON -U, I -ION CO. <br />P.O. Fit?X 304 <br />SJOCK111N, GA -95213 IHSIPRED r'' <br />(T_U9) 931- 1020 <br />FAX (209) 465-3006LICENSE <br />-124 <br />* * * * * rI" �,...®'f REPORT PORT * �i � 1i � LEONARD F. Qj,Sp <br />OWNER OF SITE: <br />ADDRESS: ) c �O.Y�'J 7,1P:!:>c?���C� <br />OWNER OF TANKS: <br />ADDRESS` _ CITY: _ _ - _ ZIP:_ <br />OPERATOR AT LOCATION._- <br />ADDRESS: CITY: ZIP: <br />COIJNT'YA�'iUgll.bl_ TANK:AGf::�_L?t� GAi,i,()NS:. <br />METAL( ) .FTBERGI,ASS(%,,/) SINGLE WAI,I,ED(V-) DOUBLE WALLED( ) <br />DIESEL.( ) UNLEADED ( ) PREMIUM UNI,. (Y-) jcty" <br />SUCTION( ) SIJBMERSIBI,F-N-) OVF.RSPII,T, CONTAINER**YF,S(V) NO( ) <br />SHEAR VAI.,VT?'*YF,S( ) NO('V) IN-I,TNE TEAK DET'EC;TOR"YESN) NO( ) <br />VAPOR RECOVERY SYSTEM**YES({-) NO( ) 1F YES, PHASE IN) PHASE I1( ) <br />TANK FILL DATE: __-j'. TIME: _ <br />TANK TEST DAT F.'T(j 11, �. _ START: 4,- (0-, _ END: <br />LENGTH OF TEST. <br />TANK BOTTOM TO GRADE.....___I <br />GROUND WATER ABOVE <br />TANK TOP TO GRADE .............. <br />,'.__.. <br />DTAIvTF,TER ....:........................ __ <br />(Tit <br />TEST LEVEL ABOVE GROUND.. <br />___10 <br />t`'AT'F,R IN TANK ...................... <br />- <br />DEPTH FOR TAKING SAMPLE... <br />-(q I <br />TEMPERATURE PROBE DEPTH.... <br />(0-__" <br />TEST LEVEL. TO TANK <br />GROUND WATER ABOVE <br />TANK..... _{ " <br />PSI ............................1..................... <br />®..b J <br />NET TEST PRESSURE .......... <br />............._.4.,t0o <br />APT SPECIFIC: GRAVITY ................. <br />53,5 _ <br />TEMPERATURE.................................--_-l�i__ <br />_ <br />APT SPECIFIC GRAVITYo <br />60' F......- <br />COEFI- ICI ENT OF EXP ...................... <br />. ..iX <br />LEAK RATE PER/IIR:f___ <br />I_ / e 4391 <br />CERTIFIEI) TIGHT: YES( ) <br />NO( ) <br />PRODUCT LINE TEST: SUCTION( ) PRESSURE( ) <br />LEAK RATE PER/TIR: <br />CERT'IFIF,D TIGHT: YES( ) NO( ) <br />I)ATE:-PZ�I�''--------- SIGNATURE OF TESTER:; <br />COMMENT'S:_--))_,%..._ t- ',o fps -i ire' �o r wi C a __.. <br />