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L <br />L U VacuTect"'TEST T <br />CHNOLOGY FORTANKSD THEIR ENVIRDNMENT <br />Owner Site # <br />Invoice Name/Address <br />Site Name/Address %2/0 �-2'sl- <br />S.O. # <br />1 <br />Date - „�� - ' �y <br />Phone <br />Attn: <br />TANKS <br />LINES <br />Leak Det <br />See <br />D. <br />For <br />LOC. <br />Tank <br />Product <br />Tank <br />Capacity <br />Ullage <br />Tank Dipped Dipped Probe Water Bubble Air <br />Dia. & Water Product Water Ingress Ingress Ingress TANK <br />Material Level Level Level Detected Detected Detected ■ <br />ST/ i ■ ■ ■ ■ ■ Tight <br />FRP/ START START START or <br />Lined END END END Yes/No Yes/No Yes/No Fail <br />Line # <br />Line <br />Material <br />N <br />ST/ <br />FRP <br />line <br />Delivery <br />Syst. Type <br />■ <br />PS/SS/GS <br />LINE <br />TEST <br />■ <br />START <br />TIME <br />LINE <br />TEST <br />■ <br />END <br />TIME <br />Final <br />Leak <br />Rate <br />a <br />GPH <br />LINE <br />■ <br />Tight <br />or <br />Fail <br />Exist <br />LD(s) <br />Pass/ <br />Fail/ <br />or <br />NONE <br />NEW <br />LD(s) <br />Tested <br />& , <br />PASS <br />TANKS and LINES Tested to CFR -40 Parts <br />280-281 & NFPA 329 Specs. <br />Other: <br />1 <br />2 <br />�✓ <br />5 V rJ <br />�I v� <br />�/ <br />Ru i <br />t® <br />jam/�j <br />s <br />10,000 <br />IamUter / <br />/ (� <br />l�. I� <br />'f <br />�y <br />J l� <br />St <br />�°'• _/ <br />(°c <br />J � <br />(°- <br />0's _ <br />/" <br />Q <br />�'` <br />�3 <br />( <br />/ <br />`✓ I���� <br />Z <br />�J`�✓ <br />/Its f' `C'� <br />lJ /J <br />�T �•• �+ <br />/�g •� /� <br />W ri yg,p ' <br />,. <br />•3�- <br />/ <br />•� <br />J. _.. <br />T <br />�f• <br />p e� p / �y y� <br />Exist LO SiV/MOL/MFG:II�y.S .� ✓ ii 41 4fL�, <br />New LD SN/MOVMFG: <br />LINE TEST PSI <br />Dispenser Shear Valves y <br />O ate ss/no <br />Exist LD SNIFADL/MFG: <br />New LD SNIPADL/MFG: <br />LINE TES' PSI d <br />Dispenser Sheaf Valves e0 <br />.2=91 s eslnol <br />Exi51 LD SN/MOVMFG: '� � ✓�L /y` ,.J <br />s G! <br />New LO SN/MDLlMFG: <br />LINE TEST PSI ,•sem <br />Dispenser She Valves ✓�� <br />e 6esffiol / C <br />ateris' Percent o Fill at mp <br />Start Tfine: Time of Test: ? Mf .: /� ry1 <br />T nd Ti L an roe nc inometer „e <br />Q I Test PSC • 00 Entry: r' D r s: <br />Q s/tameter <br />_(ate7✓overcenitot11 akS� <br />Ump yam+ / <br />Start Time: Q I f Test: Mf .. / o /1 e "P-7 <br />/End Time: L 3 Test PSI: 100Ent e �i `! Delmeoemeter <br />®® <br />Iameter <br />� + <br />7 <br />aterfa er nt o d at ump ff <br />Start Time: Time of Test: .. t�lL ! <br />,rMf <br />S / C3 ct O 7 Tent Psl� t�fJ En a I+—.. �% Inclinometer �. <br />-End Time: <br />1151ameter <br />Iameter 0 <br />(m^ CJ <br />�i <br />••+ r <br />G 3 -W ca <br />J <br />O(/✓ -]Q <br />_ <br />' f - <br />� <br />Exist LD SN/MVMF <br />DG: <br />New LD HN/MDL/MFG: <br />LINE TES" PSI <br />Oispensp Shear Valves old <br />race Shea / C <br />Material Percent0 1 at ump <br />Start Time: d / Time of Test: Mfg.: <br />Tank ro a Inclinometer � s Cy <br />S% End rime: Test PSI: - 210 Entry: - ' % Degrees: O <br />Exist LD SN/MDL/MFG: <br />New LD SN/MDL/MFG: <br />LINE TEST PSI: <br />Material erce , o dl at ump <br />Start Time: Time Of Test: Mf .. <br />lank Probe Inclinometer <br />End Time: Test I: Enta: De r s: <br />Dispenser Shear Valves <br />rate (es/no <br />Iameter y, <br />Exist LO SN/MDL/MFG: <br />-Wa-Fe—ria7 <br />New LD SN/MDL/MFG: <br />LINE TEST PSI: <br />Percent of Fillat ump <br />Start Time: Time of Test: Mfg.: <br />Dispenser Shear Valves <br />O rate(Yes/no) <br />an robe nc ometer <br />End Time: T t I: Ent D mr <br />TANKNOLOGY Region: ! t 0 Unit # State Lic. # C / _ 11� *w- State: <br />NOTE: Original VacuTect Data recordings are reviewed by Tanknology's Audit Control Department and maintained on file. <br />TAK-01 <br />Tanknology Corporation International <br />5225 Hollister St., Houston, TX 77040 <br />(800) 888-8563 9 FAX (713) 690-2255 <br />