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Data6hart for Tank System T�htness Test <br /> LEASCPA NT <br /> 1. OWNER r+arr.T❑ - Z,p P•p....n,al•w Twpno+w <br /> Tana Ia 1 <br /> Add— Z-D P•p•s••iauw Two^o^• <br /> LJ ^. ti. <br /> 2. OPERATOR „de— Z,p T-0 .-- <br /> Mawr <br /> 'TE5ULATION GOVERNING <br /> r <br /> 3. REASON FOR <br /> TEST 16 OF CHAPTER 3 TITLE 23 OF THE CALIFORNIA ADMINISTRATIVE CODE <br /> tF,ptain F41y) - <br /> 4. WHO REQUESTED r1W •rkw,+•to Du. <br /> TEST AND WHEN <br /> Add— <br /> zio T•Iwrwe <br /> ta«r,rer <br /> by Direction Uq•r�ry Br«W pO�w C+sde b0r04.W. <br /> 5. TANK INVOLVED (t 'L.I� �ti tTFFL, <br /> CJs+ddit nn.l Yew <br /> kar tttanito,a-d tank■ - <br /> �wr Filts V•nla &p^o^es Pi ps <br /> 6. INSTALLATION V3G h()eT'� <br /> DATA ©Fjf, ,T"I 0 r} <br /> .,Til•ti4_k•.OMO $ul:1.On,Pemal•, <br /> Nonh inr:dr Cri.way, co,KC•14.stack TaP. 1 F,trs Site.kua tdlded I VVhkh tanksl Wke it rno�n <br /> iter ae suli .•1c E nft,etc. tread. "" <br /> Is the-10c 0. tee tank? <br /> 7. UNDERGROUND ©Yea No <br /> WATER D.pt"to a--.tw tabW tr«n grad. <br /> 8. FILL-UP Trnka to t»tiu.e Na.^. T.Irpewn. <br /> ARRANGEMENTS bva prod -1 to-WO pte t+w eu,t.nk""'� "°"''"d�Oto p,0"447 (y seder NO Lead. <br /> 1E <br /> -TR.ww.l or atom contra <br /> te+nmurs a inpuiry N.ne T•t•Mo•'� <br /> 9. CONTRACTOR, <br /> MECHANICS, <br /> my a,her c0nvactor <br /> kn. _d <br /> 10. OTHER <br /> INFORMATION <br /> OR REMARKSa,c.Prro45e4,Y�taOr,W aes•r+<rs pre, t c,rr,ng te.l,e,c. <br /> Addre^al inbrma,on On a^y hems aDp•e.D11Kia1,W a,n•r1 b t+r e0•,rd.nen 1•,Irnp H n propleat <br /> 11. TEST METHOD � PETRO TITE ❑ PETRO COMP ❑ QUICK CHECK 2000 <br /> Testi rear made On Che stare lank systems h acmedrnu with test procrdums pas wltxd for <br /> 11 a. TEST RESULTS a.eetalted on et Cbc d legit d,•rta wlth«sults as lobo-1: <br /> T.nk ta,e,ri+:Ca„or, Tignt <br /> w.,Vo+.^•Cnaro•Pw I Da+•Ter+ed <br /> 12. SENSOR 13. CONTRACTOR CERTIFICATION <br /> CERTIFICATION <br /> t EL,L, CHAMPION'S PRECISION TANK TESTING <br /> T.etrnp[o.tr•ctw«Corw.^r- sy: ygn.t„r. <br /> 13�Z-(4 P.O. BOX 13059 SACRAMENTO, CA. 95813-3059 <br /> 1 1-800-660-9443 <br />