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�IIIIIII ChampionPE ox13059 <br /> iemenoo, CA 95813.3059 <br /> Precision Tank Testing CA 800-660-9443 <br /> Licence No. 73848 MAR 15 1999 NEV 800-949-9443 <br /> r-it:!";iTi''t (916)1 927-1557 <br /> Fax: (916) 927-7345 <br /> PERMIT / SF7WICES <br /> HORNER EZY-CHECK CERTIFICATION <br /> Owners Property Tanks(s) <br /> Company Q T /�aoT r Phone_( <br /> Address An �e 31346 - <br /> City ST tKTom State '01q, Zip <br /> Name& Location of Company <br /> Company /l R—d 6cn7i Phone_L_) <br /> Address 3v8o 6 'fAae-0)T­' r Al <br /> City State_____tA Zip <br /> NOTICE TO OWNER(S)l 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 L 'SiS J <br /> - <br /> ---------------F <br /> Tanks to be filled Date: SJ - z - y'> Time: JK.Ott <br /> Distributor Extra Product to top off iD v <br /> Comments <br /> REPRESENTATNE(S)OR OWNER(S)WILL BE NOTIFIED WHEN THE TEST HAS SEEN COMPLETED AND ONE OFFICIAL MUST BE PRESENT DURING <br /> THE FsTNG. ALL TESTS MADE oN THE TANK(s)SYSTEMS ARE VALID THE HORNIER-EZY CHEK LEAK DETECTION PROCEDLQES. <br /> TMS CERTIFICATION sHOws THE CRITERIA ESTABLISHED BY THE NATIONAL FIRE Assoc.(PHAMPLET 329). �/ <br /> Test Results Include Tank(s) C9�Line(s) Lel Vapor Recovery System L7 Vent Line(s) B'� <br /> Tank Tight Tight Leak/Per Hr. Leak/Per Hr. Date Tested <br /> ID# Tank Lines Ind. Tank Detected Line <br /> Y N ❑ Y ®'Nes� ❑ �s <br /> 2 T <br /> 2- Y CYN ❑ Y & N ❑ aLS3B' �ef77Aw <br /> Y ❑ N ❑ Y ❑ N ❑ <br /> Y ❑ N ❑ Y ❑ N ❑ <br /> Technician: ` a"A )D- lg Certification #: <br />