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E <br />m { <br />w <br />Z <br />z 30 <br />o <br />z <br />C <br />DATA CHA'RY <br />For Jso With <br />,r T14 <br />t)3 O L , f t1 v _- <br />1 LOCATION :----—------- ' - <br />StraanJ!or Co,.x. Gity Ste to telephone No. <br />2 OWNER:_'sL�__L�`a�—__L(1\_�Z®�/3—_-- <br />Nama S.easss Reprosente ti.a pout'.. Telephone No. <br />3 OPERATOR: �/ — -- ---- <br />�, (( Ne •e iaeia4 Mpr. of Other Address (II oillerant then Locoviory Telephone No. <br />4 REASON FOR TEST <br />5 TEST REQUESTED BY: <br />Nam* <br />8 SPECIAL INSTRUCTIONS: <br />7 CONTRACTOR OR COMPANY MAKING TEST <br />MECHANIC(S) NAME (—�- <br />8 IS Af)•-T• TANK TEST TO BE <br />MADE WITH THIS LINE TEST? <br />10 WEATHER <br />Position <br />Order No. <br />Billing ^Gams$ <br />- TEMPERATURE IN TANKS` OF 'C <br />COVER <br />OVER LINES <br />Concrete. Black Top. etc. <br />APPHUXIMA I t <br />BURIAL DEPTH <br />11 IDENTIFY <br />EACH LINE <br />13 LOG OF TEST PROCEDURES, <br />12 TIME AMBIENT TEMPERATURE, � <br />(MILITARY) <br />14 PRESSURE <br />15 VOLUME 18 TEST RESULTS <br />psi OR kPa <br />READING ( <br />NET CONCL'JSICNS, REPAIRS AND COMMENTS <br />CHANGE <br />BEFORE AFTER <br />AS TESTED <br />WEATHER, ETC. <br />I <br />BEFORE AFTER j <br />I <br />I <br />I <br />AJ TAT <br />fico <br />00 Z- <br />a <br />/,Lf7 <br />02-7 <br />CIO <br />�xP(� <br />Tt <br />oZ4- <br />,bZ7 <br />;oe1 <br />1335' <br />1-& cE rA��e <br />0` 2- <br />i <br />1--- <br />