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Sacramento Equipment Maint-virnance Company Inc <br /> 2533 Connie Drive Cala.Contr. License x502377 <br /> Sacramento, CA 95815 rare 62205 <br /> (916) 925-2716 <br /> PLEASE PRINT Data Chart for Tank SysteM_.; i9,Ptnes.&T-0StHStSL ,x <br /> I. OWNER Papw E] _ 5150 Wilshire B1 . L'os An eles , Ca . ( 213 )983-7156 <br /> Tank rEl Nu <br /> ) nr Adds« Rap,nenrtln Talepherr <br /> Nam• Address Representative Telephone <br /> 2. OPERATOR 4579 E. Acam o Acam o, Ca . ( 209 )368-7534 <br /> mare Address Ttlapnow <br /> 3. REASON FOR County Permits <br /> TEST <br /> (Eaplaln Fully) <br /> 4. WHO REQUESTED Same As #1 <br /> TEST AND WHEN New Thle Compayor Alnllnbn Dal <br /> Addrev T•lephorr <br /> bemify by Direction Capacity ennd/suppli,r Orada Approx.Ape 9«I/Rherpla« <br /> 5. TANK INVOLVED nottill �-.vuv LAC4 V^ 2c — <br /> V� Ic �C vv h4 P-'t j�12cm for <br /> Additional ling SuJ{n f UJO Itf N� Utnl.fKp '— cc <br /> bio meMloldad tanks <br /> Lcoatbn Coro, Fille v«b s1pho"i0a PYTPs <br /> 6. INSTALLATION u� ee•� <br /> DATA E#4.54- c'" <br /> North mala driveway. C nota,Sack Tp, size.Used arks.Drop Suction,Rarnoba <br /> Rev of tuition,etc. EaM,atp tuba.Particle FM Baa,bar,tor which banks? IkYke a bran <br /> 7. UNDERGROUND r hewne aw the rN? <br /> WATER Caper bthe water rba Iw � ❑T« <br /> S. FILL-UP TM,to ba am m. Dete Arlsrw by M.n a Telephone <br /> ARRANGEMENTS Ens podat to'top or and tun bank rarer. Lbw and wlr b p,*Adal consider NO Lead <br /> T•mYw or sew pontes <br /> %or netice ca Ineu bay <br /> Campany Maar Tolsphor <br /> 9. CONTRACTOR, <br /> MECHANICS, <br /> any other contractor <br /> Involved <br /> AY <br /> 10. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> AddfibrW Ybrmatbn M any aerie above.OmUtla a gher b a dare seen rdklp Y b prop,e«a aorrptated.Vleilwa a oD«r«r pyre aueYq feet.etG. <br /> Tests were made on the above tank systems in accordance with test procedures prescribed for <br /> 11. TEST RESULTS as detailed on attached test charts with results as follows: <br /> TM b«aambn Tlpm Loebape Skewed pts Tsbd <br /> 1, q I <br /> 5 t a07_ ll 41 <br /> uv.lcao GS 4Ole IRA/. glf qt <br /> 12. SENSOR 13•This is to certify that theca tank systems were tested on the date(s)shown.Those Indicated as"Tight"meet the criteria established by <br /> CERTIFICATION the National Fire Protection Associatlon Pamphlet 929. <br /> Technicians ti's Me responsibilhy d e owner andtm operator of Nis system to inmediatey edvl«sate and tical aauarai«d any <br /> Ors M y� mulledazd N <br /> hard and pcceiblliry of any reportable pollution b mmW the ei,onent as a resof fineindicated failure of this <br /> t, j fJCJL r system.Heath Consultants Incorporated andlor SACRAMENTO EQUIPMENT MAINTENANCE COMPANY,INC.does not <br /> 5 V���O a some any respo slWl ry o,liability bio any ass of product m M anNronment. <br /> Bvlal W.at Thermal Cereficolon a s� <br /> Bonsor <br /> I 4,;'nFi"..�C wo? nye' <br /> Certification a R/�y��Cr�OF. Tank Omer/Operalw,v `� Data FL_ J� <br /> 101 <br />