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OIL EQUIPMENT SERVICE STATE LICENSE No.323417 <br /> CLASSIFICATION: A-HAZ.,C61D40 <br /> Division Of Keith A. Tallia, Inc. STATE ENVIRONMENTAL ASSESSOR No.01781 <br /> Telephone: (209)754-1808 <br /> Fax: (209)754-5726 <br /> Post Office Box 950 <br /> 750 Industrial Way <br /> SAN ANDREAS,CALIFORNIA 95249 <br /> HORNER EZY-CHECK CERTIFICATION <br /> Property <br /> Owner : (! 2AICG 'F fIA,zi/LTal j t1E,4T Go.-ui?¢tiy <br /> Address - 7-;;Z/ N uZ;:oti+ '5T, 0 4 . <br /> Tank Address : <br /> *Notice to owner(s)* A copy Of this test result has been filed with the proper regulatory <br /> agency. It is the responsibility of the owner(s) to contact the local Env. Health Dept. in <br /> his or her area of any tank failure within (24) hours of testing. <br /> Tank# Product Capacity Apx. Age Steel Fiberglass Supplier <br /> r' t7i�C / f?o�o •� <br /> Tanks) were filled on: Distributor : <br /> Date/ Time <br /> Extra product to top off:_No[y' Yes[ ] Gallons <br /> Comments : <br /> TEST RESULTS INCLUDE <br /> Tank(s) L Product Line(s )SG Vapor Recovery System Vent Line(s ) <br /> Tank Tight Tight Leak indicated Leak indicated Date of <br /> ID4 Tank(s) Line(2) per hr. (tank) per, .hr. ( line) testing <br /> --L—Yes No[ ]Yes['3')Jo[ ] x•03 -TWC <br /> Yes[ ]No[ ]Yes I ]No[ I <br /> Yes[ ]No[ ]Yes[ ]No[ ] <br /> Yes[ ]No I ]Yes[ ]NO[ I <br /> Yes[ ]NO[ ]Yes[],NO.[ ] <br /> Yes[ )No[ ]Yes(]No[ ] <br /> "echniefan: [fib t / License *:297m- f 7 Date: <br />