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. . —..,.�,r �. <br /> TELA-LEAK ITM \I- TANK CERTIFICATION c ebERGROUND TANK TESTERS, INC. <br /> REPORT 917 W. Bellevlew a Porterville, Ca 93257 <br /> Phone(209)781-6508 <br /> Property o " - _ O z v C <br /> OWNER'S Name Tnepnone <br /> NAME Tank(s) C V - /Z.o A o / r <br /> Address City Lip <br /> SA A S A / o u G <br /> NAME OF �„e Tekpnpne <br /> LOCATION <br /> Address CA, Zip Cwnry <br /> 6.0 Ln <br /> �Lu TICE TO OWNER:A copy of all test results have been filed with the proper regulatory agency governing underground <br /> storage systems. Yes [jili [IIf not filed. see explanation below: <br /> JUN 3 1991 <br /> LN�1FWi4TAl HL.E <br /> Location of agency where filed —1,44 \11/L 0�J M (>N i AL 4 C r i <br /> D oCA, 95 LQf <br /> 7 T -fin! Q L.[14 IL \A14 LC t[ r L( ,a 1"/o I <br /> REASON FOR <br /> TEST <br /> (Explain Fully) NOTICE it is the owner's respormaity to contact the environmental health department of any failures within 24 firs.of the results <br /> given to the owner. <br /> L l `. <br /> WHO REQUESTED Name Date <br /> TEST AND WHEN? 7 E - 6 S , T = S r0O /: 7 0 1_.) <br /> Address Teephore <br /> =De (il kUreclwn CaPacly 6 ativikseker Orale Apgox Ape sleet r Fiberglass <br /> nown' <br /> REM OR SYSTEM TESTED <br /> TANK ONLY aiii I OOJ C/fCYYtoN V6rt� /too 1 Al - ❑ ❑ <br /> PRODUCT LINE Z- tA r,w ❑ ❑ <br /> VENT LINE LTA ❑ ❑ <br /> VAPOR UNE ❑ ❑ ❑ <br /> ALL OF THE ABOVE ❑ <br /> FILL-UP Tensile be fined - N. Dale <br /> ARRANGEMENTS Dude' <br /> twee <br /> Eska product l "Np ofr (g) NO <br /> u L VI iii el oV & 74,v Wocn^ 12AIraila- 47,1 <br /> OTHER U .M1I Q A Q Aj YA7 c l Co 12 A ni.7A,ts, , T Al jito! <br /> INFORMATION •+ µ Nk-4 T rgiTEb Q <br /> OR REMARKS S f N? <br /> Addnlonalmformahon on any near,above.Officials or others to be advised when Nei is in progress or completed Visitors or observers present during <br /> test etc <br /> Tests were nude on the above tank systems in accordance with TEL-A-LEAK Detection test procedures prescribed for as detailed on <br /> TEST RESULTS attached hold sheets with rawks as follows' <br /> Tank a Treat Tank Tight U. IWkree snecirao Tank LeaNee lne,Lared Liri Dale Tani <br /> TANKS I 2.. Yes No O Ye ❑ No ❑ <br /> PRODUCT LINES B"'. Yes ❑ No O Ye O No ❑ <br /> Atamr*Vent Yes 13 ' Yes ❑ No ❑ Yea ❑ No ❑ <br /> Lines Included No❑ Vaa ❑ No ❑ Yin, ❑ No ❑ <br /> Yes ❑ No ❑ Ye ❑ No ❑ <br /> CERTIFICATION This is to cartity that these tank systems were tested on the dates) shown. Those indicated as'Tight"meet the criteria established by <br /> _ the National Fire Protection Association(Pamphlet 329). <br /> C1'D DENNIS E.GOODAN <br /> TEL-A-LEAK 1""' operator UNDERGROUND TANK TESTERS,INC./By:Slgnature <br />