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Data f; -rt for Tank System TigVA ess Test - <br /> PhtR Itr_oo Titeb <br /> PLEASE PRINT VVV [JItM <br /> 1. OWNER Property ❑ Stockton Unified School a District Bill HRaawr«mNreniit ( 209)944-4078 <br /> Tonk(s) ❑ raison High School 14L7 Jo . Center , Stoc" nMe (209 ) 944°-"°4078 ; <br /> wens Adorn &prewt»wa iehono« <br /> 2. OPERATOR S . 701 No . Madison Stockton , CA (209 )944-4078 <br /> Nnna Address TeleehoM <br /> 3. REASON FOR Regulations <br /> TEST substances subsha ter 16 of chapter 3 of title 23 of the <br /> (Esplam Fully) California Administration Code . <br /> 4. WHO REQUESTED Bill Harmening Maintenance S . LI . S . D 6/12/86 <br /> TEST AND WHEN Ads. This, rorea.ny of ARNeeon Dow <br /> 701 No . Madison Ave . Stockton CA 95203 ( 209 ) 944-4078 <br /> Add»u Telephone <br /> 5. WHO IS PAYING S • m - <br /> FOR THIS TESTI y �o`y°'�°a�"ison ocktoon ra. Te ono« <br /> &IWrrp A°dreee Chi w» Zip <br /> Attention of: prow No. Other Ir»urrcuom <br /> Identify by Direction captchy Innd/Suppler Grade Approx.Ape Swl/FrbrpWF <br /> 6. TANK(S) INVOLVED 500 RpniilAr <br /> 610-0-0-10-10-0-0- Diesel <br /> Location Lover Fills Vents Sphonee Pumps <br /> 7. INSTALLATION rt� G FI eA*- fAk'fki j l Sar Tlo a' <br /> DATA 7� �G✓rs< FA> tr 4 �pr'I t, A'eer <br /> Nonn k»Ida driveway. Genuses woe Top. Lce.TleMlh nuts.Drop i Luct»n.Rano». <br /> Ree,of mils,,.W. 4M,etc. Nva«.RMON Fwr ilea WNtalood WNch onto 7 Yak.It known <br /> S. UNDERGROUND is the wow on,the tank <br /> WATER Depth m the waw table ❑ r« ® No <br /> Tanks to be Pobd hr. Date Artunped by <br /> 8. FILL-UP r1e"'a Te1'O"°na <br /> ARRANGEMENTS Fina product to"lop off"and run TSTT. Mow and who b provide 7 Consider NO Lead. <br /> Terminal or othw contact <br /> for notice or inquiry ` <br /> I;omcenr We» 1'Napnau <br /> 10. CONTRACTOR, Ale,' <br /> MECHANICS, <br /> any other convector <br /> involved <br /> 11. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> Addnwnal intormatgn on any ilemt above.OH¢u4 or others W M Wvwd when Wtirg s in progress a IwmptlW.Vunws or I>A«rrM present <br /> owing tat etc. <br /> Tom wrne tntetN on the&bow tank&yaane in accord rive with tool prooadure&PropcFWW tr 5�'ER� <br /> 12. TEST RESULTS w delrled on a tached the Charts with n&ube w tottowe. <br /> Tank Identiticenon Tight Loakspe in .osted Dau Tested <br /> ^. <br /> C ri <br /> cr ^ <br /> �'j <br /> Y <br /> This M b eertRY thN""tank&YNeme were IMted Ort fit&d&Itye)mown.dhow Ytdictled Y"TIyhY'It&&1 the OtNerl&&el&bpetnd bT o <br /> 13. CERTIFICATION rhe Eve. r rtn Aeoortwn►rnphla M. <br /> Fre t . <br /> /' INVIRONbIEGT,AL PETROLEUId ENCN <br /> Oaw •�_—— � --� --rMna enuua�er ni r rrrv» <br /> PO. 60R 2076, STOCKTON CA 95201 <br /> 4rw No WTO ---1—«t•ruc»nr <br />