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- DataChart or anSystem Tightne<Zs Test
<br /> LEASE Paltry GHAPIPIONr.S--grI2LCTSION TANK
<br /> OWNER Prep.ny
<br /> Iv Q Neme Add—, n•n•e.enl.bra Te.ep"Ona
<br /> Tank($)
<br /> Name AdBr... n.p,.eenlel.+• Tele pnpne
<br /> 2. OPERATOR
<br /> Ne.n. 'n Add, . ,eupnone •
<br /> 3. REASON FOR REGIBAL TION COVF,RNING UNllLRGI2UUNb S'1'Ult/�GL U1 11AZAI2DOUS SUBSTANCLS -
<br /> TEST SUBCIIAI"TER 16 OI- CIIAI'TER 3 01' 'I T.TI i-: 23 01' Till-.- CALIFORNIA ADMINISTRATIVE CQDE
<br /> (Capin.Fully) "-._-•--."_-
<br /> <. WHO REOUESTEO OWNER
<br /> TESTAND WHEN "•T' ,.n. can p.nr e,At,1...,en o...
<br /> Adp•... ---'-- - TNeOnOne
<br /> 5. WHO IS PAYING WNrR
<br /> FORTHIS TEST 7 ce.pr ivy.AeenCr a,ind...dv.. ,r1r. T.Lpnen.
<br /> a.u,nd Add'... C.,. Sul. I,p
<br /> Atlent.on or: o,or.No 01nrr In.l,u(1,ena
<br /> Identify by Dveet.on Capacity n.,nd/S..0Pl•e, Grad. Apr o..Age St,z/F.berglast
<br /> TANK(S) INVOLVED U —ny"Zy _ �E
<br /> n l 4
<br /> Location Cover Fdh l Vrnls - S,phonrs Pumps
<br /> INSTALLATION V7eC7An r_
<br /> DATA O fz Le—r
<br /> 5 '° �� �E
<br /> Norm innde drn.wey. Conere%e Stec\ Too. S,ce.T.lebrl-.he Oson make i .emote,
<br /> Raer of fI.I.On•sic (erlh•.Ie. lub.. R.mo1e F,.I. $,rs,M.-fold.d Wnr(la len\f Me\a rl\.Own
<br /> 8. UNDERGROUND It the w81.1 0-1 five tank)
<br /> WATER Depth to the Water table 0 Y.s El No
<br /> S. FILL-UP Tanks to be f.brd h1 ( 0.1, Arleng,d by —`
<br /> ARRANGEMENTS Extra product to"top off"and run TSTT Now and who 10 pro-111 Comdr.NO Le.d.
<br /> m)XA CC, __ _._-..---------
<br /> Ye—nal or other contact �.. e �\N 9� � —(,sq w*, �'T-f1
<br /> for nobCe or.no carry L � y1,�.. .A. r CI`'•1 ll
<br /> co—o—, N.rn. T<.e0nonr
<br /> 10. CONTRACTOR, -- — ---- — -
<br /> MECHANICS.
<br /> any other contactor
<br /> 11. OTHER �� -----•--
<br /> INFORMATION ----
<br /> OR REMARKS
<br /> Addd.nna.nlprm.bon on any.lemf ahnve U't c.a.a r••O".r,f 10 br aA+,arA -r.rn I.N,ny,a u.piny,,%%or co-pt,trd V.%•tor%m obs ervrrt p,ese nl
<br /> dul.ng I,%t sic
<br /> Tests were made on the above lank systems to accordance w.ih test procedures preecrrtted for lTl•,'1'120—'l ITJ:
<br /> 12. TEST RESULTS as dela.lyd on attached iesl Charlt -.th resuhs,e% 10110-5:
<br /> Tans ld,nt.t.r neon Lgnl trr.n;e L.n�l nl.d .. . _. .. _ U,ie Tr%„n ---
<br /> _._. . .. _..........
<br /> I
<br /> This is to certify that these tank systems were tested on the dal,(t) shown.Those indicated as"Tight”meet true eras+is established by
<br /> 13. CERTIFICATION the National fire Protection /1soc.ahon Pamphlet 319
<br /> (:flA,"lPJON'S PRI?(;1S1.0N TANK TESTING
<br /> Vit. S.p.. 13,-059
<br /> _t `t 1CRAtiI;N'I'O i CA `5°��
<br />
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