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CRIsp TANK TC- STyqMa1' 0 <br /> P, O,. BOX 30487 V <br /> • Stockton, California <br /> .. (209) 931-1828 J-AN-1-0 1990 <br /> ENVIRONMENTAL HEALTH <br /> TEST REPORT PERMIT <br /> OWNER OF SITE <br /> ADDRESS y 27 �a�/P„ CITY <br /> STATE C�ZIP It <br /> OWNER OF TAWS_,_$_a/» C a 5 a f n r <br /> ADDRESS CITY STATE ZIP <br /> OPERATOR AT LOCATION L o 0, <br /> ADDRESS $p ;; C Prn � / _ CITY STATEL0 ZIP <br /> NAME OF COUNTY <br /> TANK 0 {7 /7 F, ON PLOT PLAN. AGE OF TANK <br /> DESCRIPTION OF TANK: <br /> CAPACITY Ocl, ,DIAMETER y METAL < FIBERGLASS_ <br /> TYPE OF SYSTEM: SUCTIDN : SUBMERSIBLE OTHER <br /> VAPOR RECOVERY SYSTEM?� q ; TYPE • <br /> PRODUCT BEING TESTED <br /> uiAs r ��/% MEASURED GRAVITY • <br /> API SPECyyISSEEEIMMC GRAVITY 8 600F ".�g};ODLICT TEMP.(�D COE, QD/J2XZ7 <br /> STORAGE F1LlE0'_ DATE_')- a7-• "' 9 TIME <br /> TESTED - DATE <br /> LENGTH OF TEST`)_ l_ ;; q , START G 9 D " , FINISH <br /> MEASURED WATER IN TANK_, HEIGHT OF LIQUID LEVEL <br /> DEPTH OF GROUND WATER —' ,;i p • PSI AT TANK BOTTOM , — <br /> RESULTS OF TEST: ' <br /> CERTIFIED TIGHT? - YES _; NO IF NO EXPLAIN IN REMARKS. <br /> LEAK RATE PER HOUR: + i 2L2/ 4l• ; or <br /> i' <br /> REMARKS BY OPERATOR <br /> NAME Or OPERATOR <br /> SIGNATURE OF OPERATOR <br /> DATES— <br /> _—' _ ----- <br />