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III II,I Champion P.O. Box 13059 <br /> Sacramento CA 95813-3059 <br /> Precision Tank Testing CA 800-660-9443 <br /> License No. 73848 NV 800-949-9443 <br /> 1-916-927-1557 <br /> Fax: (916) 927-7345 <br /> Date:"l-CQ_a!n <br /> Site ID: (' bl'Mp <br /> Operator:�t )N u)E 6T- l_t Q L)0 A <br /> Site Address: 1 1 <br /> City: .� State: C.A On Job Site Time: D'1yv <br /> Zip: 5 a Phone:';- ):e - 31-z- I pica Off Job Site Time: <br /> Precision Leak Detector Test -F.T.A. <br /> Tank# 1 Tank#2 Tank# 3 Tank#4 <br /> Product <br /> Serial Number D " ' ✓'� I "T I <br /> Resiliency i `bra 1Mt <br /> Opening Time rJ -"" -"-Fl^ <br /> Test Leak Rate "> `u, <br /> Functional Element <br /> Holding Pressure I z 1 11 11. <br /> Metering Pressure i <br /> Pass Pass Pass Pass ❑ <br /> Fail ❑ Fail ❑ Fail ❑ Fail ❑ <br /> Comments: <br /> TECHNICIAN: William Campbell - LIC. 90-1324 Signature 1h 1.� Cert#12S jj^. <br />