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(EZY CHEK) <br /> '-! <br /> CLIENT <br /> NAME OF SUPPLIER, 1 <br /> OWNER OR DEALER _ t / frJG J1 ! DATE OF TEST ` '`''�TT_M1 START > TIME FINISH 0 77 LENGTH 0 T �•- '� <br /> ADDRESS(NO.&STREET) fL_51 /1/ H,ljWEATHER o ` TEMPERATURE_ 3` <br /> CITY AND STATE nT- <br /> TANK INFORMATION L <br /> CAPACITY(NOMINAL) ? _GALS. SIZE OF FILL OR TEST OPENING -r IN. CONTENTS(PRODUCT)I-LJa)4er <br /> CAPACITY(CHART) GALS. TOP OFF TIME —HOUR;r')-) DATE f a- ,a-^ GALLONS TANK MATERIAL METAL i ) "IBERGLASS N6 <br /> DIMENSIONS: DIAMETER NUMBER OF GALLONS ADDED TO START TEST— I J APPROX.AGE <br /> LENGTH TANK NO. PUMP SYSTEM TYPE-SUB( ) rvIAt4E <br /> INCHES OF WATEA - BEFORE TEST 'r AFTER TEST SUCTION <br /> LEAK D <br /> TEST CALIBRATION ETECTOR YES - NO <br /> TANK LAYOUT VAPOR RECOVERY SYSTEM YES(-) NO ) <br /> SIZE OF CAL.BAR OR MUS ADDED <br /> • L <br /> (ALM) (F%CTOR AI . <br /> LINE MOVEMENT <br /> 1 r to 9 5 / LINES <br /> 2 a 4 to = LINES <br /> 3 __to LINES <br /> TOTAL_ LINES _3 = _ f LINES <br /> (ALM) <br /> END OF TEST CALIBRATION <br /> SIZE OF CAL.BAR OR ML'S ADDED <br /> ,AL.Mi (FACTOR A) <br /> LINE MOVEMENT <br /> 1 to = LINES <br /> 2 to ' _ - LINES <br /> 3 - / to _ LINES <br /> TOTAL - - LINES _ 3 = LINES <br /> (ALM) <br /> MEASURED API SPECIFIC GRAVITY <br /> PRODUCT TEMPERATURE <br /> API SPECIFIC GRAVITY a 60'F (FROM TABLE A) <br /> COEFFICIENT OF EXPANSION 0 R/4 7A L f- r✓79 a, Ei r.t r Lb D h la / (FROM TABLE B) <br /> dD d /4 x 5 5 0 (FACTOR B) <br /> C.O.E. TOTAL CAPACITY IGAL) L.CHAN F ) <br /> PROCUCT UNE TESTING SYSTEM / I 1 <br /> PROpUCTMONITORINGON� OWNER OF SITE ICt�"i�G9 keOtU5 ADDRESS 150 al. }J?V <br /> rime Reading - Product Serial Number I - <br /> M I(arl I No- Slant End +Gaan X Factor A +Gain CITY dna_ STATE �, ZIP CODE <br /> 4-mH oss <br /> .003 OWNER OF TANK ADDRESS( ,�r��r <br /> •00 ) CITY {( �i ) STATE ( a ZIP CODErbo�'Tl - r <br /> .Do <br /> 00 - COUNTY ,.,} <br /> ml <br /> TECHNICIAN(S) DATE <br />