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ALLTPVH PETROLEUM S"VICE S <br /> 17759 Buttercup Circle, Sonora, CA 95370 <br /> (209) 532-7320 Fax (209) 533-2650 <br /> California Tan:Tester: 1068 California Contractor: A 623541 <br /> UST MONITORING SYSTEM TEST DATA SHEET <br /> Facility C T-&V, CC, Owner it Date z� 17-X77 <br /> Address 0 (00 S. 144R1-AN DR. Address IOO i3ox z 7 <br /> City "Tµ-R O P CA 4 533o City IL CA '► <br /> Annular probes: <br /> Product Visible si n ofproduct? Probe operational? <br /> 1 D � NO `Ifs <br /> 2 <br /> 3 <br /> 4 <br /> Pipin 3 sump probes <br /> Product product in sump? Probe operational? Positive shutoff? <br /> 1 OF Nd 4 $ NO <br /> 2 <br /> 3 <br /> 4 <br /> Dispenser sump probes: <br /> Product Product in sump? Probe operational? Positive Shutoff? <br /> 1 NONE <br /> 2 <br /> 3 <br /> 4 <br /> 5 <br /> (6 <br /> Overfill alarm: (Type: OA,LAF L4 A-t } Other: (Specify: 1\j00 e- <br /> Product Operational? Product Operational? <br /> 1 Dr- -i - 1 <br /> 2 2 <br /> 3 3 <br /> 4 1 14 <br /> Remarks: <br /> Tank Test Technician: —x .Pv Mike Dotten, License # 1068 Rte-616196 <br />