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Data Chart for Tank System Tightness Test <br /> pP1ro T�tP <br /> TANK TESTER <br /> PLEASE PRINT <br /> 1. OWNER Property ❑ <br /> Nems ^% i., AOdrsaa C � � ! ��.. ;' r'/pmasnutly TsNDnone <br /> r <br /> Tanks) ❑ Homo Addrw Reroen <br /> ootative Taleotane <br /> 2. OPERATOR Name Addteas telephone <br /> 3. REASON FOR <br /> TEST <br /> (Explain Fully) <br /> 4. WHO REQUESTED Name tide Company or Athliatiort Onto, <br /> TEST AND WHEN <br /> Address TsieDMM <br /> 5. WHO IS PAYING Company.Agency or Individual Porton Authorizing 'rise TeleWrone <br /> FOR THIS TEST? w <br /> Billing Addreta Ciq Suu <br /> Attention of: Order No. Other instructions <br /> Identify by Direction Capacity Brand/Supplier Grade / Approx.Age Steel/Fibuglass <br /> 6. TANK(S) INVOLVED we <br /> Location Cover Fills Vents Siphons P in <br /> 7. INSTALLATION 7-E+/� 1oA)e. eT r� 2 rt T <br /> DATAp�P� /e�y <br /> North inside driveway. Concrete.Black Top. Site.The is make.Orap Suction.0�• 1� <br /> Rear e1 ails°",etc tank sic. tuoes.Remote FWs Size.Manilolded Which links? &Aske k kit vert <br /> is the water Over the lank t <br /> 8. UNDERGROUND <br /> WATER Depth to the water table r>*'t�sCl� 'J'iy�s//�� ❑ yet ❑ No <br /> Tanks to be railed W. `a/ 2. <br /> gDate ARanq•d by <br /> Ne <br /> S. FILL-UP Maine Telephone . <br /> ARRANGEMENTS Extra product to"top ofr•and run TSTT. Now and who to provide 7 Consider NO Lead. <br /> f <br /> Terminal or other contact <br /> for notice or inquiry Name TMeDttone <br /> Company <br /> 10. CONTRACTOR. <br /> MECHANICS. <br /> any other contractor <br /> involved <br /> 11. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> Additional information on any items above.Officials or others to be advised when testing is in progress or completed.Visitors of observers present <br /> during test etc. <br /> Tests were made on the above tank systems in accordance with test procedures prescribed for PP..rovilk- <br /> 12. TEST RESULTS as detailed on attached test charts with results as follows: <br /> Tank Identification Tight Leakage Indicated - Date Tested <br /> yam/ r/;•�t1 .r - r ii7.'t i fr .•i '2 <br /> i <br /> This is to certify that these tank systems were tested on the date(s)shown.Those Indicated as"Tight'meet the crlteds established by <br /> 13. CERTIFICATION the National Fire Protection Asoelation Pamphlet 329. <br /> Lawrence Tank Testing <br /> Oats P.O. BOX 407 y: Signature <br /> So"No.of Thermal Toohnicians . Downieville,California 95936 (916) 289=3109 <br /> Sensor <br />