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I I Champion P.O. Box 13059 <br /> I I Sacramento, CA 95813-3059 <br /> Precision Tank Testing CA 800-660-9443 <br /> License No. 73848 <br /> NEV 800.949.9443 <br /> > (916) 927-1557 <br /> Fax: (916) 927.7345 <br /> HORNER EZY-CHECK CERTIFICATION <br /> Property <br /> Owner :_19On 5 <br /> Address : <br /> Tank Address : 15600 S J4CIJ1617 Rd �lGv>aR�P G <br /> *Notice to owner(s)* A copy of this test result has been filed with the proper regulatory <br /> agency. It is the responsibility of the owner(s) to contact the local Env. Health Dept. in <br /> his or her area of any tank failure within (24) hours of testing. <br /> / Tank; Product Capacity Apx . Age Steel Fiberglass Supplier <br /> v <br /> Tank( sj were filled on: 9 -/-9 y Distributor : <br /> Date Time <br /> Extra product to top off :_N'9�Yes ( ) Gallons <br /> Comments : <br /> TEST RESULTS INCLUDE <br /> Tank( s )Y-Product Line ( s )� Vapor Recovery System Vent Line ( s )�_ <br /> Tank Tight Tight Leak indicated Leak indicated Date of <br /> ID# Tank( s ) Line ( 2) per hr . ( tank) per hr . ( line ) testing <br /> Yes[ ]NO[ ]Yes [ ]NO[ ] — ^ - - <br /> YeS [ ]No[ ]Yes [ ]No[ ] <br /> YeS[ ]NO[ ]Yes [ ]NO[ ] <br /> YeS [ ]NO[ ]Yes[ ]NO[ ] <br /> Yes[ ]NO[ ]Yes [ ]NO[ ] <br /> Yes [ ]No[ Y s [ ]No[ ]_ <br /> Technician:_ License # : 0/56 Date : -oC` <br />