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3 ' <br /> N <br /> p ♦ LI <br /> Avg* POB 36 265ISN. Sacramento Bh@. HYAnnualMouitorCertfflcation o <br /> Thornton,California 95686 Cn <br /> (109) 794-0102 (800)524-9087 FAX(209)794-0112Annual Spill Bucket Test o <br /> TEST DATE: <br /> Fa 6e fal <br /> SITE NAME: 1Y 0 0 - v e Gei torsi p sensors Job Time TMMCurr rues: Lyle A Mmmo •• <br /> OTTL97-1143 tens easy O,�_ O`er <br /> Ounerr ratxName: <br /> Site Addrms- /5_&&D0) O 4i-j ^. , TECH 5tGK&TURE: <br /> Ent.Health Agency: <br /> Phone: ( ) INSPECIORsueE: 5r,00 Q e-t <br /> 5izp Not Present • <br /> Printout:Included <br /> MONITOR61ske e� Stoad): r <br /> v"' I :arab �fdj� Printout:G iren tolnspecto <br /> to to S f— <br /> TANK ID:Ql Sz: ID&Nr Sz: ID. � , Sz: Sz: <br /> In-Tank Guaging Probe # 1 /sj;, / t i�,.a f,, <br /> Annular Space or Vault Sensor# X .J IW4oco X p/7D 6r//E(HCX) <br /> PipingFiping Sum /Trench Sensor # X �4ap4aB/p x %D,� ac-reagin �CgaOF3�d� aoAGL"/b <br /> Fill Sump Sensor # <br /> Mechanical Line Lk Detector # X J VfX <br /> Electronic Line Lk Detector # <br /> N <br /> Tank OverfilltHigh Lcl Seosor4 ❑ <br /> 0 <br /> Other (s eclb-) -See Com meat S <br /> M ",pt Sz: ID: irsr/ Si: 1D:p ;�,�/Sz: ID: <br /> L7 rS a/Sz: m <br /> In-Tank Guaging Probe <br /> AnnularS acearVaultSensor# ru <br /> Pi in Sum 1 � <br /> FRI Sump Sensor <br /> Electronic Line Lk Detector# 7 <br />