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HomeMy WebLinkAboutNotification for Underground Storage Tanks and Permit - Permits - 1 MASSACHUSETTS AVENUE 10/22/1993 Department of Public Safety Division of Fire Prevention and Regulation Notification for Underground Storage Tanks STATE USE ONLY --- - tD NUMBER FIRE 0EP1, Submit ta: � LOCAL, k'111E DE'P 1R`1`HEN'!' _DA` E RECEIVf�f7__._'�`��' A. Data Encored Into Computer _❑ A. NEW FACILITY B. AMENDED C.CLOSURE� ._ _ _�_ ,_ _ _ _ 0, Data Entry Clark Initials Yr' No„of tanks at frtcllity No.of canEinuaEion shoots attached C, Owner Was Contacted to INSTRUCTIONS Clarity nosponses, Commonls Please lyQULpdaj if j[Ih all items except wsignaturo"in section V. Pils farm must be comf>lolod for each location containing underground storage tanks, If more than live (5)tanks are awned at this location,photocopy the following - sheets, and staple continuation sheets to the form. Notification Is required by Federal law for all underground tanks trial 3.septic tanks; hove t4an used to store regulated substances since January 1,1084,that 4.pipeline fadiiries(Irsctudinq gattwrfrrg lines)regulated under the Natural Gas are In the ground as of May 0,1086,or that are lit"uQlit Into use attar May 0, Pipollno Safety Act of i968,or the Hazardous Liquid Pipelino Safety Act of 1079,fir 1980,The information requsateel Is rsqufred by Sectlon 9002 of the Raaourc, whidt Is an inuastato pipoiino facility regulated under State laws: Consorvatlon and Recovery Act,(RCIIA),so amended. 0„aurfoca Impoundments,pit$,ponds,Or lagoons; 8.abeam water o waste water collection systems; The primary purpose of this nattficallon program Is to locals and evaluate • 7.now•dirough process tanks; undotground tanks that storo or have storeal pouotoum cr hazardous substances. 0,liquid traps or associated gathodno linos directly related to oil or gas it Is expociod that die Inlormation you provide,will be based on roasotabfy production and gathoring operations; available records,or in the absence of sudi r000ds,your krscrMfidgo,belief,or 0,storaoo tanks situated In an undorground area(such as a basement,cellar, recollection, minowoking,drift,shah,or tunnol)If trio storage tank Is situate,upon of above the who Must tlotify?Soction 0002 of RCRA,as anlorxlod,requires Vial,unless surfara of Uro tbo. exempted,owners o!uriiorground tanks prat storo regulated substances must What Substances Are covered?Trio nolfication roquiromenis apply to under notify designated state or local agendas of Via existorsca of Utolr tanks.Owner ground storage tanks that contain regulated substances„This Includes any means— subslarlca dolined as hazardoua In to don 101 (14)of the,Comprehensive a)In Via case of an underground storage tank in use on Novornbor S,1084,or Envfronrrrontal Response,Compensation and Liability Act of 108E(CERCLA),with brought into use fitter Vial date,any person who owns on undorground storago the sxeeptbn,of dose substances roguiatod as hazardous waste under Subtil;e C of tank used for die storooe,use,of dispensing of rogitlatod substances,end RCRA.It also lncludos petroleum,e.g.,crude oil or any fraction the'rool whiclt is b)in Vie,base of any underground stooge tank In usp bolero November 8, liquid at standard conditions of temperature and prossuro(60 degrees Fahrenheit 14.7 pounds per square Inch ahsaiuta). t984.but m longer is use on Ural date,any parson who owned;Audi Yank " knmodiatoty before the&confinuatim of Its use, 't'f'isrte To Notiff" Completed noidicaoon lorm, 0hould b: writ to ncc addr,•— c)If the Stale agency so requires,any facility dint has undergone Any dianges tt€rc tr at the lop fit brit.tarc to facility Information or tank system stntus(onfy arnondod lank Informs on needs to be lnctudod)• VNhal 1'nnke'Aro itrcludod?Undergrourvd storage tank Is defined as arry one or combination of tanks Vial(i)Is used to contain an accumulation or`re, ulolod when To Notify?1,Owners of underground storage tanks in use or Vial have tubstanos;And(2)whoso volurna(Irxjuding connactod underground piping)is boon taken out of operation allot Januory 1,1074,but still In die ground,must rwriry to°Y or morn bonnatlt the ground.Soma examples Pro underground tanks storing: by May 8,1086,2.Owners who bring underground storage tanks Into use after May 1.Gasoline,used oil,or diesel fuel,and 2.Industrial solvents,pesticides, 0,1086,must notify w€dtin 30 days of bringing Via tanks into use, hertrlcides of furrttganis. Whet Tanks Ara rrxcluded?Taroks removed from the ground aro not subject to notification.OUrar tanks excluded front notification are: penalties:Any owner who knowingly falls to notify or submit a false 1.Iarrn or re0dontial tanks of 1,100 gallons or lass capacity used for storing Information shall be subject to a civil panally riot to excaod$i0,000 for each nato fuoi for noncommercial purposes; lank for which notification to itot given or for which false Information Is 2.'uanks used for ator-Ing heating oil to cossurinpUve use on die promises - aubmlttod. tviroro stared; �.._... . ....�_,,�....I, o,vNPISfilt'OF rnNl<.�.. (S) 11, LOCATION OF„rANK(S) 11 aoquYa<D I v atafo gghv tt�a gaaprrtrhb tacxltnn U trtr try looters,mfnutes,and recvndt. anipke L t 42,96,12 N L 6 ,24,17W Nafiv uirat.4r�ddtc�af:sw,oaelW�n,Mdir'�ival,lIuralh^P mrrc ort3iher .�n / LHIttUdO t.OngItUde,, „,--_____._ tr y, _ (N o srra so$ed kxt I,mruk tax horn n) _ Fr4llky Nara a coasrnny she kSda iti rpn.rNo r !�a";:7"�,_' LIP cocTo 8tlovt nddrms(11.0.[lox nod sccw,�slots) ...... Page f fr' 7rt 1=„tx, 290 (rev, 10/90) w r , 111. TYPE OF OWNER IV. iNDIAN LANDS Tanks are located on land within an Indian Tribe or Nation: Ej E=odoral Government 0 Commercial Reservation or on other trust lands, ❑ Stale Government Q Private Tanks are owned by native American Ej Local Government nation, tribe,or individual, V. TYPE OF FACILITY Select the Appropriate Facility Description _Gas Station Railroad Truck ing/Transport Petroleum Distributor Federal- Non-Military �_Utilities Air Taxi(Airline) Federal• Military Residential _ Aircraft Owner industrial Farm _ Auto Dealership Contractor Other (Explain) VI, CONTACT [)EnSON IN CHARGE OF TANKS Name Job Titlo Address Phone Number (include Area Code) ', /��e,;d �,Ca. r comer, VII. E=INAtJCEAt_ RESPONSIBILITY I have mat the financial responsibility requirements In accordance with 40 CFI Subpart 1-1 l —— Check All that Apply - _._.__f ',)all I `Gunarantoo state Funds' ,ael1 Insurance Lelin Commercial Insurtrnce Surety Bond Credit Trust Fund F Surat i _ �_.__--_ Other Mothod Allowed Specify E�i.,Ec f�oterrliorr Group ._—__� f � �— after comploting all sections) Vill. CERTIFICATION (Read and sign alto µ ____ ------�--- I certify under penally of law that I have porsonally examined and any famillar with the information submitted In this and all attached documents, and that based on my Inquiry of those Individuals immediately responsible for obtaining the information, I believe that the submitted information is Inre,acc,•urato, and complete, i Name and oElrcial title of owner or owner's authorized representative (Print) sfgnaluro� Dace signed i t EPA eslima1es public roporling burdon for this form to averago 30 minutes per response Including limo for reviewing instructions, glatherir,g and rrraintaining the data noodod and completing and roviowing the forty', Sand comments ragarding this burden esl'errrale to CNN, lnformal',,m Policy Branch PM-223, US, Environmontal Protection Agoncy, 401 M Street, Washington D,C, 20460, marked `Ationlion Dnsr, (Ah(;or for FE'A."This form amends the previous nolif'rcation form as printed in 40 CI:R Part 280, Appendix 1. t Page IX, DESCRIPTION OF UNDERGROUND STORAGE TANKS (Complete for each lank at this location.) rink ldonilficalton Numbo� Tank No.� Tank No. 2`:- Tank No.� Tank Na. Tank No. �� 1. Status of Tank (mark only one) Currently In Use Temporarily Out of Uso In.�b IK wl V 1 Permanently Out of Uso Amendment of Information 2. Date of Installation (mo,lyear) ?is { t} 1 U c Cf ?U 3. Estimated Total Capacfty ({gallons) a{r-� p-Ct•U � c'O & Material of Construction (Mark all that apply) _ �--------1 Asphall Coaled or dare Stool Cathodically Protected Steel f Epoxy Coaled Steel " i`- Corttposito (Slnnl with riboi gins) �� t• --� �— 1(- -- �� Fiberglass Reinforced Plastic `— Lined Interior Double Walled - Po€yethyleno Tank Jacket i Concrete Excavation Liner - Unknown • Othor, Please specify _ Has tank boon repaired? A(v 5, Piping (Mate arr) {l,fari� all that apply) [care Steel _ -- Galvanized Stool Fiberglass Reinforced Plastic Gopper Cathodically Protecled _ r Double Walled Secondary Conta€nmont — Unknown E—_J Othor, Plonso spoclfy G, I'ip'srtg (TYPO) _-- (Mark all that apply) Suction: no valve at lank K J [ _ "--� X — Suclion:valvo at lank _ pro SSUM Gravity Food Has piping boon ropa€rod? — __ Page 3 Tank lOntification Number Tank No. _ Tank No.-2— Tank No. 3 Tank No. Tank No. 7. Substance Currently or Last Stored In Greatest Quantity by Volume Gasoline Diesel Gasohol Kerosene Healing Oil X— x K Used Oil Olhor, Please spocily Hazardous Substance CEnCLA name and/or, CAS number - - - - ----- - - -- -- -- - -- - ---- - -- -- ----- - - - -- - - - - Mixture of Substances Please specify « X. TANKS OUT Of USE. OR CHANGE IN SERVICE t. Closing of Tank A. Estimated date Iasi used — it (mo,/day/year) E3. Estimate dale tank closed — — — -- .�. .(nzoYldaylyear). C. Tank was romovod from ground D. Tank was closed in ground r — E. 'rank f'sllod with inort material C_ L Describ© F. Charade In sorvico �. Sap Assessmonl Cornplelod Y l I L __.. 1--------- Fvidonco of it kink dotoclod Page 4 XI, CERTIFICATION OF COMPLIANCE (COMPLETE FOR ALL NEW AND UPUHAULU r ANr b A IN Ib LUUA110114) Tank Identification Number Tank No. Tank No.J Tank No, Tank No. Tank No. 1. Installation A. Installer cortiftod by tank and piping manufacturers B. Installer certified or licensed by the lmplemonling agency C. Installation inspected by a registered engineer ' D. Installation Inspected and r X �C X approved by Implementing agency --� E. Manufacturer's Installation chock- _ lists have been completed F. Anothar rnothod allowed by State agency. Please specify. L— 2. Release Detection(Mark all that apply) TANK PIPING TA NK PIPING TANK PIPING TANK PIPING TANK PIPING A. Manual tank gauging B, Tank lightness testing 0 Ewl ICJ l C. Inventory centrals E—J I t___� 444 D. Automatic tank gauging 0 ElL�j E . 1(apor monitoring X x i-tid 10 � x I 1 0 0 U F. Groundwater monitoring � � � � � � L---�l G. Interstitial monitoring double walled LI El tank/piping f (��������� / onda � CU I_.. 1 11. Interstitial monitoring soc ry 1. Automatic line leak detectors F �� L J. Line tiglotness testing __� r� � K. Other rnothod allowed by L___ _1 L —J Implementing Agency. Please — specify. 3. Spill and Overfill Protection r C7voilill device installed A. B. Spill device instaltod OATH: I certify the information concorning installation ill is provided In section X is true to ihe best of nog ballet and knowledge, Installer: Name _ company Position Page 5 IX. DESCRIPTION OF UNDERGROUND STORAGE TANKS (Complolo for oach lank al this location.) Tank No. Tank No. Tank No. Tank No, Tank No.^ _ Tiknk'Idonlification Number — _ 1. Slatus of Tank (mark only ono) Curtonlly in Uso Tomporwily Out of Uso Pormananlly Out o1 USo aft mrril,..b R,wS,,clm IX Amondmont of Information 2, Dato of Installation (mo.lyoar) f 17( -- — — -- :3. EskniatodVTotal Capacily (gallons) —�� coo - 4. Malarial o1 Construction (Mark all 1fiat apply) Asphalt Coalod or Onto Slool Caftdically Prolocind Stool Epoxy Coalod Stool Corn �oallo 51on1%Y11h f Iffol plugs Fibeiglass Rainlorcod Plastic Llnod Interior Double Wallod _ Polyethylene Tank Jad<el _ l ------- concrete --� - -- Excavation liner Unknown • Dihor, Pleaso specify I ias lank boon rep airod? - a :— (1,1wk M lhrit €q ply) taro Slcel — Galvanlzod Stool - L f=ibertdiass Rolnlorcod Plastic ---- Coppor CaihodicaBy Proloctod Doublo Wallod socondary Contaifulloni -- lJialcnuwn Ulhor, I'loaso spocify G. f'ipinq (-rypo) -- - (t,4�;ric _ i ipi}: nn e+alvo ;it V;d"'11 tat tank ---...' I I l I I tank Idonlifiralion Numbor --~- --- -Tank No.� Tank Nam _ Tanit tJo. —rank Now_- -Tani: Ho. 7. Sub>lanco Currontly or Last Slotnd In Grnatasl Quanlily by Volurno -- Gasolino Diosol Gasohol Ilualinq Oil Usod OiI -- Other, Ploasa spacily f;I_RCLA narna nndlaf, _-��--- CAS number --- — __ — -- _- -_ Mixluro of Substancos f'loaso spoc'rly i ---- X. TANKS OUT OI' USE,OR CHANGE.IN.SERVICE 1 1. Closing of Tank A. fslimated data Iasi used - -- — (uio.ldaylyear) D. t_,I'!w;ito dalo lank closed _-----_______-- (mo,ldayly©at) - -- C, Tarll( WaS (Orn0VOd ffOM ground^ t}. 'J'ank was CIOSod in ground F. Tank, filled wilh inert rnalorial t=. Char 3�l in sotvico Evidonco of n l+:s}I( doloctod XI. CEnTIFICATION OF COMPLIANCY (COMPLETE FOR ALL NEW AND UPGRADED TANKS AT 1141S LOCATION) -- Tank No. Tank No. Tank Idonlificalion Nurnbot Tank No. Tank No. Tan1c No. -- t. lnstallalion _ _ 1 A. Inslallor corlifiod by tank and piping manufaclufors B, Installer carliliod or liconsod by lho lrnplonanriting agoncy C. Installation inspociod by a f� rogistorad onginoor L r D. Installation inspactud and. approvod by irnplomonling agoncy E.-MAnuiacluror`s inslallat-son chflck - fists havo boon comploted F, Anolhor nanlhod allowod by Slate at}oncy, t'loasn specify, _ _�__.�--•- t !I ltaG 7At�I. PIPING TANK PIPIt�tGl �tAl�tfC � °Inl#E`= 2. Roleaso Dotection (Mark all that apply) `I ANJ( PIPING TANK: '' ' Cl E-I E A. Manual tank g-migingi [�J - 13. Tank lightness testng r_.�� ( — I I [ U C t� k C. Invonlory controls U, Automatic lank clanging r— E� ED (-71 � �r ED CJ EA C� u L_. I E. Vapor monitoring 1 ID r. Groundwalor monitoring l G. fnlnrslitial monitoring double walled �. � �J Ej �� _ I I. Inir r.,i,lia monrtnr ng Y conlami-nont [ � E Jl 1 I�� I. Automatic Zinn Ioak dolaclars L � J. Lino lightness lasting I<. Ulhor rnothod allowod by — — — — Irnpfonronting Agency. 11I0oction — I, cs;=:dill dovi;o instrsllod I}. ;,V,d€wino inslallod L-_— -_._ — — I'. I : ry lia{a infcztt,,a,licyr, r.c,ric:{=rninrt inslriflr,liort Ih:)I is proviclr_-d in sncl;on X is IWO to Iho hest ()f 111y laclief rar:d knov,l ^_;c'. - &x The COmmonwealm of Massacj,jjjs(�tts ' Department Of Public Divisi011 of FirePrevelij- IMI and Regulation APPLICATION FOR P�; IA11 YO MiNIriN AN EXISTINGMEW UwD` O: Head of Fire Department i�C)RAG FACILITY �3� �rJUi�t� City, ToivrI or District _ _ _ Octber 03 Date Application is hereby made for a pexinit to ►naj.nta:i.n underground storage facility as x, existing/neGv wired by ,r� an?7 C,4tft 9.00: z'ex�r�)its. Location Ofpropert,y:-�..___1.,=3._Ma.s.��,va,_ Street Address ------ Owner of property: _i'atob Realty Trust Mlfl, lwul-lo of lwv'oll) filili 01' CoI,fx)I'll t.i.01I - - Signature of owner or. authorized representatives F'EE: $ (M.G.L.A. Chapt. 148 See. 10A) 1=orlIA r.F'>. 290 (rev. 10/90) (Fire department's copy to be filed With F.P. VDU Part 2) The Commonwealth of MassachuseUs == Department of Public Safety Division of Fire Prevention and Regulation APPLICATION FOR PERMIT TO MAINTAIN AN EXISTINGMEW UNDERGROUND STORAGE FACILITY TO: Bead of Fire Department Nn_ Ando�r October 2.2, 19 93 City, 'Totivn or District Date Application is Hereby blade for a peiznit to inainta.in an existing/llew widerground storage facility as required by 527 011R 9.00: Permits. Location of pi-operty: Street Address Owner of property: patob Realty Trust (MVO) PU A 11(tlll[➢ of i)ersoji i .f izill oz, curtm,110_e11 Signature of owner or authorized representative: FEE: $ � n (II.G.L.A. Chapt. 148 Sec. 10A) i ff For{tA F.P. 290 (Fire department's copy to be filed with F.P. 290 Fart 2) (rev. 10/90) { _ The Commonwealth of M ssachusetts - - Dep art,rnent of Public Safety r , Division �f I i e Prevention and regulation PEf?M11 Oct. 22 , 1993 Pete TO MAIN-rAIN A.M. EXISTING/110,11; U gnERGRQUIrD STORAGE FACIL.IT Y In accordance with the provisions of 527 Ckin 9.26 this- permit to maintain an existing/new underground storage facility is granted to: -Location of property: 1-3 Mass. Ave,:, street address Owner of property _ Patob Realt 'rust MVO : full name of person, firm or corporation Restrictions: Fee Paid:$_ 10 no� -- (M.G.L.A. Chapt. 148 Sec. 19A) f� l 19 4 �C c� lf� This permit will expire 10/2 �'G G.2 oinred daelgnee Date sionafure of dead of Fire Dept, or Opp FORM F.P. 290 (rev. 10/9o) (Owner's copy to be posted at the storage facility) GLOBAL TANK SERVICES9INC- ,I Srjn,�erswmth, PIH 03878 603 692 7917 - 1-800-262-0106 August 20, 1993 ATTN: William Dolan North Andover Fire Department 124 Main- Street North Andover, MA 01845 Dear Sir, Global Tank Services, Inc. recently performed underground storage tank tests for the Merrimack Valley Oil Company located at 3 Massachusetts Avenue in North Andover. Enclosed you will find the Fire Dept. report along with our result and data chart sheets. If I can be of any further assistance to you, do not hesitate to contact Me. Sincerely, SERVICES, INC. GLOBAL TANK SE Donna M. Simmons Business Manager GLOBAL TANK SERVICES, INC. 4 Turgeon Lane • P.O. Box 678 Somersworth, NH 03878 603-692-7917 1-800-262-0106 August 20, 1993 ATTN: William O'Brien Merrimack Valley Oil, CO. 3 Massachusetts Avenue North Andover, MA 01845 RE: Underground Tank Testing Results Dear Bill, Global Tank Services, Inc. recently performed Horner EZY-Chek Leak Detection tank tests on an underground storage tanks at the above mentioned site. The tests were conducted by certified technician in conformance with the National Fire protection Association Pamphlet sy stems. e stems�arehasrfollows�f the tests performed on Y NET VOLUME DATE TANK SIZE TANK PRODUCT RESULT CHANGE 9 8/11/93 20,000 gal # 1 #2 oil passed -.0211Gph 9111193 20,000 gal # 2 #2 oil passed -.0014Gph $/12/93 20,000 gal # 3 #2 oil passed +.0143Gph $/12/93 20,000 gal # 4 #2 oil passed -.0065Gph (manifolded together) 8111/93 20,000 gal # 2 oil 2 oil passed -.0002Gph 811.1193 10, 000 gal # We are sending a copy of this letter and reports to the North Andover Fire Department if youteavet-o any�.-lquestions or need assistance please do no Sincerely, GLOBAL TANK SERVICES, INC. Donna M. Simmons Business Manager GLOBAL TANK SERVICES, INC. E)ATA CHART FOR TANK SYSTEM TIGHTNESS TEST (EZY 4 TSomersworth• 78 NH 003878 603-692-7917 1-800-262-0106 CLIENT DATE OF TEST TEMPERATURE NAME OF SUPPLIER. WEAKER OWNER OR DEALER ADDRESS(NO.&STREET) -' CITY AND STATE IN. CONTENTS(PRbDU T} ZA TANK MATERIAL - TANK INFORMATION GALS. SIZE OF FILL OR TEST CPI=NIN{s GALLONS APPROX.AGE CAPACITY(NOMINAL) -�n GALS. TOP OFF TIME CAPACITY(CHART} ` PUMP SYSTEM(APE} _ NUMBER OF GALLONS;ADDED TO START TEST DIMENSIONS: DIAMETER TANK NO. * �., '" AFTER TESTS---- LENGTH � INCHESOFWATER - BEFORETEST�.�--- UNKLAyaUT TEST CALIBRATION (AUKI (FAR AI SIZE OF CAL BAR OR MI:S ADDED ------- LINE MOVEMENT 2 LINES icnoiN6 to SS-------' LINES Town 2 tom - LINES LINES Lbw«g 3 -no c 3 to TCTAL _ LINES I- 3= (Aue) pw.•ab[ END OF TEST CALIBRATION (F(Aue) SIZE OF CAL BAR OR ML'S ADDED LINE MOVEMS T �� [a LINES z _ LINES 2 to LINES LINES 3 to FATAL (Auer MEASURED API SPECIFIC GRAVITY (FROM TABLE A) PRODUCT TEMPERATURE (FROM TABLE B) O A 9 API SPECIFIC GRAVITY rm °F 7G- (FACTOR B) COEFFICIENT OF EXPANSION 2a ' v0L CHAHGEr F .S! X T CApAcr ry(GALL C 0 ADDITIONAL NOTES OR COMMENTS 4/-�ATE T HNt ) ` � . DATA CHART FOR TANK SYSTEM TIGHTNESS TEST (EZY CHEK) TEMPERATURE COMPENSATION NET wL CHANGE PRODUCT MONITORING ON LLR Product PRODUCT MORM IN G IN 5.P. Pmdug + � +Gaar +Gant X Faaor B L.R S.P. (Mime R Naing Start Ead = Facmr A fG sw End +� X Fatter A -LQ Start 1_•.End -iris I WCcatuattion o � 2 I 14 U .0012 Z I :4 42. 4 Z -fib 0 1. I I l o I f I I �L I I i I -Rn I i z I I I I I Lam i t I I I zl +Z I I I - I 1 3 +� I I I 1 . /z Io I I I g A. Tank Bot, to Grade Send Report to: B_ Tank Top to Grade ro3 Client a � � �oic camp GRADE --: C. Tank Diameter Address.3 f�� ofyy,� D. Test Level above grade _ q— City, State IV E. Depth of water in tank -" Phone(og ) 6b'3-313i G a F. Depth for taking sample _J asz--" Attn: // 014-C� F H G. Temp. Probe depth (connector) _" Cr:FMS XMN Thm ts W c&n y trot me tank system was uamd oa 0=s Vp .True Md-c:ad"T•tpht-meet vte rrn m esubtiseed S s P u q H. Test level to Tank Sot. —� ;I by 2,Nxt�W Fuv Qrmv==AApaton Pan OIL'329. ina N��R G-d2f:0..s/- J o I. Groundwater above tank bottom_....,Q,__" G J. Product Pressure per 1" height ,03) _PSI Tank No.-3 Tight 7j� «.ho��• Test Pressure Formula Leakage 1ndicated3 WATER DEPTH E _x�_-( ,.---x .0 )= 5 yz5 Technician G-,�+A Mnacc M EST ' Date Tested �• �+h%3 8 60 80 � ;no •} �50 1; r \ •.y0 � � 2p I �� I.? II 1 1 1+�� 1 I -+ r!f +IJ r l f l +r� r � ;� � O,• O � p' O 1 �.O �- rl 3 i�Jf I I II - II III ^ + + '• I r f I. � I p O I I I I` 11,f � Ii jh� III I{I i I i I I • I L. ,.�t ! �� mV I. I NJe O •� `dl l l V t l4 t 1•Itt ti'- � ozJ.. I t�: o till � �';� � \�.', � / �• /' l OL \ r � � Uri �,' t I 69-I✓ GLOBAL TANK SERVICES, INC. DATA CHART FOR TANK SYSTEM TIGHTNESS TEST 4 Turgeon Lane•P.Q.Box 678 (EZY CHEF Somersworth,NH 03878 603-692-7917 1-800-262-0106 CLIENT NAME OF SUPPLIER, . DATE OF TEST f f;W /9I OWNER OR DEALER i 'TEMPERATURE ADDRESS(NO.&STREc WEATHER CITY AND STATE TANK INFORMAMON a IN. CONTENTS(PRODUCT) 41-€ n;l CAPACITY(NOMINAL)��CL}� TANK MATERIAL �"-- GALS. SIZE OF FILL OR TEST OPENING -- finN CAPACITY(CHART) Z�l�I Rom/ GALS. TOP OFF TIME P GALLONS - APPROX.AGE +/ DIMENSIONS: DIAMETER NUMBER OF GALLONS ADDED TO START TEST O PUMP SYSTEM(TYPE) Q4 r b-z LENGTrI �/" //` TANK NO. INCHES OF WATER — BEFORE TEST O AFTER TEST_ — 7MK LAYOVTr TEST CALIBRATION _ SIZE OF CAL.BAR OR MLS ADDED — LINE MOVEMENT """9 1 27 _to ( —_ LINE 2 22 to _ _ LINES — 3 to LINES �Nc+S tcan�NC TOTAL L.INESi- 3= LINES { s � 3 PTA;�oZfw END OF TEST CALIBRATION ! SIZE OF CAI_BAR OR MUS ADDED . L�"� -- - '- � f,aLM) (FAGiDfi Ai :nNc•L LINE MOVEMENT to ?oL _ ZCa _LINES .y 2 q T to _= LINES 3 1! to, �I� _ Z� _LINES TOTAL -72: LINES 3 =_�� —LINES (ALM) MEASURED API SPECtF1C GRAVITY 4:cso,l PRODUCT TEMPERATURE API SPECIFIC GRAVITY o 60°F 3� (FROM TABLE A) JM+� COEFFICIENT OF EXPANSION '��Qy�pS/� p {FROM TABLE B) x VUL CH1VG51J (FACTOR B) ANK CAPAGfI"1'(GALL ...VO�L CtiAEl'F C.O.E. ADDITIONAL NOTES OR COMMENTS TAuK 0VsRFiL[ED Ton' f--ST D,f y 62cfc, " *ii /Y DATE r 9p -20 is f 4 C ap 0 0 5�� 0 Oz o r � f7g pR - � I r ay OS ��p3 GLOBAL TANK SERVICES, INC. DATA CHART FOR TANK SYSTEM TIGHTNESS TEST 4 Turgeon Lane•P.O.Box 678 (FEZY CHEK) Somersworth.NM 03878 603-692-7917 1-800-262-0106 CLIENT NAME OF SUPPLIER. DATE OF TEST T TEMPERATURE OWNER OR DEALER CJ ADDRESS(NO.&STRE!"I) '"--n.,c WEATHER ,� CITY AND STATE_ fJ jz:L( A tf)L)l W Ta 4 m r at s74S TANK INFORMATION . IN. CONTENTS(PRODUCT) CAPACITY(NOMINAL)�(Z�nn rj GALS_ SIZE OF FILL OR TEST OPENING � TANK MATERIAL Zleel CAPACITY(CHART) _2Q /3g_ GALS. TOP OFF TIME GALLONS DIMENSIONS: DIAMETER /7l NUMBER OF GALLONS ADDED TO START TEST PUMP S AGE 1. LENGTH /" TANK ND. PUMP SYSTEM(TYPE] INCHES OF WATER — BEFORE TEST AFTER"TEST--- 12XK LAYO rr TEST CALIBRATION SIZE OF CAL BAR OR ML 5 ADDEDC0 (,V — (r - LINE MOVEMENT LINT 1GT to 'TaNx� LINES 3 to = LINES TOTAL ��] _ LINES'-3 = ( } LINES �oA0iN6 7 wY•3 PI.rFr-r-orzi� END OF TEST CALIBRATION b _ SIZE OF CAL BAR OR MI:S ADDED '�� (�7 R A) LINE MOVEMENT 1 53 to — LINES p :53 _to =_ .2G LINES g to — �c LINES �^�•z 70TAL_ LINES_3=�� —LINES ao,000 eon Z. l (ALM) MEASURED API SPECIFIC GRAVITY PRODUCT TEMPERATURE (FROM TABLE A) API SPECIFIC GRAVITY o 60'F O b 3) _ (FROM TABLE B) COEFFICIENT OF EXPANSION 531 x �(FACTOR B) C.O TANK G4PACITY(GAL) �VOL GNAN F ADDITIONAL NOTES OR (COMMENTS CCH DATE f 10 ` � � E i♦ 2p � � o,,. o f � S�%1 o l ss t SIvo l ` t os� T o9 \ p6 r� Qc5 GLOBAL TANK SERVICES, INC. DATA CHART FOR TANK SYSTEM TIGHTNESS TEST (EzY CH M 4 Turgeon Lane•P.Q.Box 678 Somersworth,NH 03878 603-692-7917 1-800-262-0106 CLIENT NAME OF SUPPLIER, A DATE OF TEST TEMPERATURE OWNER OR DEALER WEATHER ADDRESS(NO.&STRE' CITY AND STATE ~ IN. CONTENTS(PRODUCT) TANK INFORMATION TANK MATERIAL. l . CAPACITY(NOMINAL),�.� GALS. SIZE OF FILL OR TEST OPENING * GALLONS APPROX.AGE /S CAPACITY(CHAFM �1GZ�LYE—GALS. TOP OFF TIME TO SCARY TES PUMP SYSTEM(TYPE) l2l' NUMBER OF GALLONS ADDED 7 DIMENSIONS: DIAMETER z LANK NO." f LENGTH .�----W-- O DATER TEST n — INCHES OF WATER — BEFORE TEST TANK L Your TEST CALIBRATION SIZE OF CAL BAR OR MUS ADDED LINE MOVEMENT to O ------LINES y _ 5 LINES iRn"5 Pu+TFo2M LINES 3 Z 5 _to - LINES is 3 =TOTALpnu+F LINES i END OF TEST CALIBRATION SIZE OF CAL BAR OR Mt:S ADDED (AL1 tFACIMR A) 7ANw�G LINE MOVEMENT _ LINES Z �LI to — LINES to LINES LINES 3 to TOTAL r Z. LINES MEASURED API SPECIFIC GRAVITY (FROM TABLE A) PRODUCT TEMPERATURE 0'F (FROM TABLE B) i�inSGL API SPECIFIC GRAVITY®6Mp COEFFICIENT OF EXPANSION _ 14.6 k (FAC7OR S) X TANK CAPACITY tGAL1 T VOL GFiANGFJ'F C.O.E. ADDITIONAL NOTES OR COMMENTS 'i21NK�.S r5 M/5liol'l2;W D W17. -6 TANK 'TRNKa � S4[sTi:MS (ji2.v i+6a•21• DATE EJ GLOBAL TANK SERVICES, INC. DATA CHART FOR TANK SYSTEM TIGHTNESS TEST (EZY CHM 4 Turgeon lane+P.O.Box 678 Somersworth.NH 03876 603-692-7917 1-800-262-0106 CLIENT NAME OF SUPPLIER. DATE OF TEST TEMPERATURE OWNER OR DEALER w +Ts t�Rric ADDRESS(NO.&STREET) CITY AND STATE .r IN. CONTENTS(PRODUCT)—n -SE- TANK INFORMATION 4 TANK MATERIAL,. CAPACITY(NOMINAL).�--GALS. SIZE OF FILL OR TEST OPENING GALLONS + GALS. TOP OFF TIME PumpAPPR S TE CAPACITY(CHART) „ NUMBER OF GALLONS ADDED TO START TEST PUMP SYS EM(TYPE) `" �" - DIMENSIONS: DIAMteR �1, I,, TANK NO. LENGTH _ AFTER TEST iIVCHESOF WATER — BEFORE TEST umK1AYOUT TEST CALIBRATION _ = t—�—o�) SIZE OF CAL BAR OR ML'S ADDED 1ALM) LINE MOVEMENT LINES , 7 to — LINES. to _ LINES 3 TOTAL LINES 3= ice) LINES END OF TEST CALIBRATION tAtJal 1�,ae'roAR )AR ) SIZE OF CAL BAR OR ML'S ADDED LINE MOVEMENT _ LINES t to LINES 2 to LINES 3 tO TOTAL_ LINES_3 = LINES 3 *6 YANK MEASURED APt SPECIFIC GRAVITY PRODUCT TEMPERATURE (FROM TABLE A) APt SPECIFIC GRAVITY 06fl°F (FROM TABLE B) COEFFICIENT OF EXPANSION _ —(FACTOR B) X T x ,GCnY ICsAi-I VOL.GHANGEr F C.O.F ADDITIONAL NOTES OR COMMENTS '73NK•'G is /Jlni,/iFDc�D ��7,.y �� �g,�/� DATE ICAN(S) l�4GG'1 p�3 DATA CHART FOR TANK SYSTEM TIGHTNESS TEST TEMPERRiURE CoI�PENWON Elpansbn NET VOL CHANGE PRODUCT kSONriDRING IN SA +Gam ��.. End + X FaGa B L1R 5P PRODUCE MON[7DRING ON LLR +� End +Gain X Faclnr A -� $IaR Tg Reading Sta<t End +� Pddnr A .-Loss � lr�uzr1 I I � - Iz z z . 4% I I I- q s l I I I I I I I I I I 7 I I A Tank Bot_to Grade - -n send Report to: cEY OfL B. Tank Tap to Grade ��-� Client /1t �Jry" e VRt co•TnJc - ° C. Tank Diameter ~ Address 5 mgss ,sv (,RARE -yr D. Test Lave[ above 5rade -� City, State OJfrvs phone(5a$) l�3-3i3/ E. Depth of water in tank O_- Attn:r3'/10'B%tom G s P Depth for taking sample --� }{ 1tY Of th5 onk ryaem.ras te•:tpd G. Temp. Probe depth (connector) �`L-� an GERnpil ;17DN Tha is to-n =e f�Thaw 1-d�ted A H. Test level to Tank Bot. -- --n Dyye Nzwrso Fib Prwecv m Assx=Aaan Pamphlet 329 329. 1. Groundwater above tank bottom — Tank No_ 5 �"�/ ° �6 7 J. Product Pressure per 1 height- 3 Tank )-PSI coos WATER Test Pressure Formula Leakage indicated-ono P�f X 236 )-_ U_� Technician G cresoa nJ�000c DEPTH a -�-X��--� � NET TEST� Date Tested g r r 93 FS � PR�SSUR£ C3. DATA CHART FOR TANK SYSTEM TIGHTNESS TEST (>=ZY CHEK) PRQDUG!MONIitJRING ON USt Product PRQDUCT MQNt7QRING IN I11S.P. Produce - TEh PERiOURE CDMP [SAi1QN MET WL CHANGE B fiGain +Ezpans�n lLfi. S P. {M tiGta�7l) ! Aeadln Start -Loa I"aaor A ± Start End + X Pacsor A Start ` End X Faaor B —Comrad= 1 f Ta Z1 1 1 11-14 J,n nl4n II - 1 -• �I I I I i ! I I � 1 ( T 2 I I I 1 I IZ I i ZIo 1 zl►L I i 1 � ,91� - : ,a ! ! I - - A. Tank Sot. to Grade 1 7/ " Send Report to: S. Tank Top to Grade �t5 Client I11 unAeK1/aresY GRADE D C. Tank Diameter Address.3 mass Aja- D. Test Level above grade =L4 —" City, State rbz-r.4 ANOOvGP,MA-it S45 E. Depth of water in tank o phone(Says) -(-?3-3t24 G B F Depth for taking sample In Sr _" Attn: ;SILL O'BRIFIJ F H G. ( depth Temp. Probe connector _ `�" p P � CEAr7K1GR7lDN l•t S ii m carsily thsf i1+4 nnk system,ras resiaE A H. Test level to Tank Sot. " On dace:sawn•The Indicatw"rigm"t°°ei Nu erae+ta earaNnhed I. Groundwater above tank bottom G °'me Napo W Fm Prvleruon A�=a ftm;.hW 329. J. Product Pressure pert" height .p_3/ PSI Tank No. •Fa�r� w,rx•5 7�+N+t• 0 Tight yEs WATER Test Pressure Formula Leakage Indicated 000ZC�A* DEPTH E /(,4�x A5 ( -036 )— e{$5'/ Technician C«,NTrncf:3oA Wc'00f, H 1 I NETT Date Tested Pri�URE J rl 1 r ` t � i I f; u C _. GLOBAL TANK SERVICES, INC. DATA CHART FOR TANK SYSTEM TIGHTNESS TEST 4 Turgeon Lane•P.O.Box 678 (EZY CHSK) Somersworth,NH 03878 603-692-7917 1-800-262-0106 CLIENT NAME OF SUPPLIER. y� __r. l,,�,.r� rn_ I r IC DATE OF TEST 19 Rol -_ OWNER OR DEALER WEATHER TEMPERATURE,_ ADDRESS(NO.&STREET) mnc� a�yrt' CITY AND STATE _ .. TANK INFORMATION IN. CONTENTS(PRODUCT) pt�S�C CAPACITY(NOMINAL) LS. SIZE OF FILL OR TEST OPENING GALLONS TANK MATERIAL CAPACITY GALS. TOP OFF TIME - APPROX.AGE - D ENS ONSH DIAMETER~ NUMBER OF GALLONS ADDED TO START�tl � ., PUMP SYSTEM(TYPE) sit M _ LENGTrI _�)- ) — TANK NO..!�T - INCHES OF WATER - BEFORE TEST AFTER TEST T NK LAYOUT TEST CALIBRATION .O SO --,a$ �� - 1 SIZE OF CAL BAR OR MUS ADDED pvM) c�atroA A) wAo�ns6 LINE MOVEMEhITCo to 5 _= ZoI LINES c RNA Pu�7 y y{ _ LINES try 2 t0 Try LINES Wrc 3 to 7'S _ = LINES TOTAL _ LINES�=3 =_ IAu�t} END OF TEST CALIBRATION S12=-OF CAL BAR OR ML'S ADDED (ALM) IFACMR A) LINE MOVEMENT ^LINES y 2 -....to 1�--=� _ LINES _ to CH LINES 3__ -- 3 3 to��r=� TOTAL ���L NES�3= (ALM) LINES :D MEASURED API SPECIFIC GRAVITY 'rL PRODUCT TEMPERATURE (FROM TABLE A) 2p!�wzaY Twr� API SPECIFIC GRAVITY 0 600 F (FROM TABLE B) Lp cCOEFFICIENT OF EXPANSION �5� �ln A a r (FACTOR B) C O x TANK CAPACITY JGAL} VOL C1iANG T'F ADDITIONAL NOTES OR COMMENTS ;AuroJ�n F)rtGt� 'D,aY ��I-o�ir i�S"irTvG• ' r DATE CNN I DATA CHART FOR TANK SYSTEM TIGHTNESS TEST (EZY CHEK) TEMPERATURE COMPEMSATIDN Nc f K3L CKkNGE FRDDUCT MDNIDRING UN LLK Product PRODUCT MDNMRING IN S.P. Produc (ExpansionLLR Time Reading +Gain +Gain Start +Gain X Factor A +� Start End }Ca s X Favor B �ont2ttion SP. I1 No. Stet End —Loa FatlorA —Lcss —Lt>ss I I I + f i ► I- i I � 3 � I I - I f I z. z l44J I z zz - � I I I F I I + l I I I 51 _ 9 ,s zo f c- 14o I I I A. Tanis sot. to Grade --I— —y Send Report to: f S. Tank Top to Grade ---�— Client V040k v4a_6'Y D/G CO l�o D I —" Address 3 mA�S t3v� GRADE C. Tank Diameter D. Test Level above grade" City, State/Yd.' E. Depth of water in tank --" Phone(5o8) 683- 3131 G $ F Depth for taking sample _J ZQ_" Attn. gii 013r,•ern F H G. Temp. Probe depth (connector) �Z" cErmPtc�crtnw rho is m ears ty maz sna gnk1QR1�r`'YOa I on acre u orm.roast mtl roue z get"Mee,me e==estaNmhed 'The N--</'A•r�.,Yr.,r ,s � .0500 G✓'+`� A H. Test level to Tank sot. �---^ o+e?4XU nW FI2 Protmim ASSOMEWn ftMPh et 3n. I. Groundwater above tank bottom I c J. Product Pressure per 1" height •031 PSI Tank No-" Tight ass -°W 6A/ Test Pressure Formula Leakage Indicated3^'cT'vo�an` WATER a .036 )- S c r_ _ Technician C.ua/Tr�c�rv�a�A G DEPTH E J-71-x-03— r NE:IEsr Date Tested 8-ii-4:� PRESSURE go 10 `\ ° 460 :1 > > a is o d ♦ '14 i � to k o - I o -��� o .P�y'•! /I'C;� �� � t V•f � r �� 9 1 r OS' ♦ S t t , os •ti oa t