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III) Illy Champion P.O. Bea 13059 <br /> Il Sacramento, CA 95813.3059 <br /> Preciston Tank Testing CA 800-660-9443 <br /> License No. 73848 NEV 800-949-9443 <br /> (916) 927.1557 <br /> Fax: (916) 927-7345 <br /> HORNER EZY-CHECK CERTIFICATION <br /> Owners PropertyTanks(s) ��oo <br /> Company CZ,4r( Ar�icrzvJ M Phone_(_, <br /> Address -72f /VQ A,' o'J �r <br /> City S 0 r K,'oa.1 _ State f . ZIp <br /> Name & Location of Company <br /> Company 5 4tirPhone_(_ <br /> Address <br /> City State Zip <br /> NOTICE TO OWNER(S)I A COPY OF THIS TEST RESULT HAS BEEN FILED WITH THE PROPER REGULATORY AGENCY, <br /> WHICH IS REASON FOR TESTING <br /> 'NOTICE'IT IS THE RESPONSIBILITY OF THE OWNER(S)TO CONTACT THE LOCAL ENV. HEALTH DEPT.,IN <br /> HIS/HER AREA OF ANY TANK FAILURES WITH(24)HOURS. <br /> Who requested When? <br /> Identify by I.D Product Capacity Apx. Age Steel Fiberglass Brand/Supplier <br /> 1 D. oaa <br /> Tanks to be filled Date- S', o -9'(. Time: <br /> Distributor Extra Product to top off <br /> Comments <br /> REPRESENTATNE(S)OR OWNER(S)WLL BE NOTIFIED WHEN THE TEST HAS BEEN COMPLETED AND ONE OFFICIAL MUST BE PRESENT DURING <br /> 1HETESTNG. ALL TESTS MADE ON THE TANK(S)SYSTEMS ARE VALID THE HORNER-EZY CHEK LEAK DETECTION PROCEDURES. <br /> THIS CERTIFICATION SHOWS THE CRITERIA ESTABLISHED BY THE NATIONAL FRE Assoc.(PHAMPLET 3291. <br /> Test Results Include Tank(s) amine s) O'Gapor Recovery System ❑ Vent Line(s) <br /> Tank Tight Tight Leak/Per Hr. Leak/Per Hr. Date Tested <br /> ID# Tank Lines Ind. Tank Detected Line <br /> Y J�-N ❑ Y ❑ N ❑ _,OcAf5- <br /> Y ❑ N ❑ Y ❑ N ❑ <br /> Y ❑ N ❑ Y ❑ N ❑ <br /> Y ❑ N ❑ Y ❑ N ❑ <br /> Technician: _ 0�=- �I�� Certification #: <br />