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Data Uhart nor Sys wn 'i lglaiiess nest <br />pektro TitP <br />AJI <br />PLEASE PRINT TANK 1ESTE "7-S4:1 4<- "7 '7 <br />1. <br />OWNER P,°p.ny ® <br />Chevron USA INC. 2 Annabel Lane San Ramon, CA 94583 (415)838-5302 <br />' <br />Tank(s)Rnb <br />® <br />Name Adds*" R.prasenugve <br />Telephone <br />Nomii, Addrass R.pres.nutive TeI.PhOne <br />2. <br />OPERATOR <br />Robert McComb 301 W. Kettleman Lodi CA' (209)368-8614 <br />Name Addrns' <br />Telephone <br />3. <br />REASON FOR <br />TEST <br />(Explain Fully) <br />Sher Bill <br />— <br />Chevron <br />'� 1-8 <br />4. WHO REQUESTED <br />TEST AND WHEN <br />Name rill. c° ny or 1 d Date <br />2 Annabel Lane suite #200 San Ramon CA 945 41 838-53 <br />A°d,eat <br />�7 1 Phone <br />5. <br />WHO IS PAYING <br />Chevron USA INC. Bob Stolz <br />er 41 38-5302 <br />FOR THIS TEST? <br />Company, Agency or Individual Person Authorizing <br />Ramon. A 94583 <br />,Q, 6;c: T.I.phdn. <br />Billing Address Crry <br />Su/& Zip <br />C <br />Attention of: Order No. Other Instructions <br />6. <br />TANK(S) INVOLVED <br />Identify by Direction <br />tank # <br />Capacity <br />1000gal <br />Brand/Supplier <br />Chevron <br />Grade <br />wasteoil/diesl <br />Approx- Age <br />4yr <br />Steel/ Fiberglass <br />fiberglass <br />7 <br />DATA ELATION <br />Location <br />see map <br />North Inside driveway, <br />flea, of station, etc. <br />Cover <br />cement pad <br />Concrete. Black Top, <br />Esrth, etc. <br />Fills <br />�/ S % ick <br />Sim Tit./ill make, Drop <br />tubes, Remote Fills <br />Vents <br />/Z '' <br />Stze, Idanllolded <br />Siphones <br />N <br />Which tanks? <br />Pumps <br />/J <br />Suction. Remote, <br />Make II known <br />8. <br />UNDERGROUND <br />WATER <br />Depth to the Water table -- L�NKrN•% <br />Is the water over the tank? <br />11 Yes f No <br />9. <br />FILL -UP <br />ARRANGEMENTS <br />Tanks to be filled SZ00 hr. 10-29-87 Date Arranged byAB PRECISION ENVIRONMENTAL(415)595-1863 <br />Name lel.phone <br />Extra product to '"top off" and run TSTT. How and who to provide? Consider NO Lead. <br />' <br />Terminal or other contact <br />for notice or inquiry <br />Company <br />Name Telephone <br />10. <br />CONTRACTOR, <br />MECHANICS, <br />any other contractor <br />involved <br />11. <br />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 or observers present <br />during test etc. <br />12. <br />- <br />TEST RESULTS <br />Tests were made on the above tank systems In accordance with test procedures prescribed for pPtrp TIS <br />as detailed on attached test charts with results as follows: "� rkstkR <br />Tank Identification Tight Leakage Indicated Date Tested <br />tank #1 Yf, C - O S/ e� PH <br />Z 9 - <br />13. CERTIFICATION <br />6-18-87 <br />Date <br />1719 <br />Sena) No. of ?henna! <br />Sensor <br />This Is to certify that these tank systems were tested on the dale(s) shown. Those indicated as "Tight" meet the criteria established by <br />the National Fire Protection Asociation Pamphlet 329. , n <br />Mark Morrissey <br />7ecnrrcuns <br />AB PRECISION ENVIRONMENTAL, <br />Tesung Contractor or Company. By: <br />