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Data Chart for Tank System Tightness Test <br /> PLEASE PRINT <br /> 1. OWNER Property❑ USA Petroleum 1261 E. 9th Street Pomona, Ca. 91766 805-485-9070 <br /> T.nxnl❑ VA Petroleum 1261- E!"i Street PomonamC 7 91766 AT-0085-9070 <br /> Name Address Represptatiw <br /> TelpMne <br /> 2. OPERATOR USA Petroleum 2500 West Lodi Lodi Ca. 95240 333-9834 <br /> Name Address <br /> Telel <br /> 3. REASON FOR ! <br /> TEST To test system for tightness <br /> (Explain Fully) <br /> 4. WHO REQUESTED Ken Green 3/6/89 <br /> TEST AND WHEN �'J$`A Petroleum 1261 fit.' 9th Street Pomona, a.dn 91766 80524b5-9070 <br /> Addroa <br /> - Telephone <br /> Identity by Direction Capacity Brend/Suppder Grade - Approx.Age - StpVFleerglaae <br /> 5. TANK INVOLVED Y I A,*r /Goo vuy Q i <br /> Lhe additional llnes e 'lu Liv •J. � + Ja;•lar W r...(. -for manifoldea tanks e k r J Al 2 PV• n. IIAd, <br /> Location Cover Flls Sipd Pum s , <br /> 6. INSTALLATION /./p.n[, yen hone ° �L�r .r r <br /> tJo4T0! CO tr CrtJce 3-{'Ir <br /> DATA gra;;ra, .•,•r G)rJ•v. 3 -a" h'o.,� 1Lo5ra,:rA <br /> NOnh inside driveway, Concrete,Black Top. Size.Tlterill make.Drp suttun,Ramose. , <br /> Pear of dello.dice' Eanh,etc time.Remote Fills Stre klnnilolded Mich tanks? Make i/known -. <br /> 7. UNDERGROUND <br /> WATERn ma water w.r the tank? <br /> Deptnuma Water Wale Be tow i(/rj uy <br /> El ea Ic <br /> C L Y. <br /> 8. FILL-UP - Tanks to ee ruled hr. Dau Arranged M <br /> Nvrw Telephone 1 <br /> ARRANGEMENTS - Extra product to lop mr and mn unx Wane Now and who to pr,aWw] Consider NO Lana. <br /> Terminal or omen contact <br /> to,notice or induiry - <br /> COmpeny Name ' <br /> Telphane j <br /> 9. CONTRACTOR, <br /> MECHANICS, <br /> any other contractor - <br /> involved - <br /> 10. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> Additional information I on»y Item,.Odra.Orticiels or others m me aW iaed when luting p in progress Or completed.visitors or oeaervem present during leap etc. <br /> 11. TEST RESULTS Tests were made on the above tank systema In accordance with teat procedures presMbed for <br /> as detailed on attached test chains with results as hostel <br /> Tank Identification Tl leakage Indicated Date Tested <br /> tl! Ahorr_l 1 E3 _.o/4y <br /> e 3 -G - s9 <br /> ou <br />_._l2._SENSOR _ 13.This is to owhty that these tank"emne were tested on tri. - <br /> NadonalFireProtectionAssociationPamphletns daWNrwwtThose lndabdrR10h1amMtMaitwlaaetadrh.dMri. <br /> CERTIFICATION <br /> —b — Techdicure -- -- - --------- -----. - - --- __ <br /> r� W �r� /4%�.z Liquid Construction, Inc. . �,,� <br /> SRieaWt9 Cenvacwr or Campup'. Br: sgnnun <br /> Sepal w.dr Tramiel c«uncatmn. ywg ii x ,� P.O. Box 1220 Tulare, Ca. 93275 <br /> Sensor <br /> Address <br /> canii;'}eft^L•'-7+r�`e+'4"R:7iD' `:Y.rrtefleNme . <br />