Laserfiche WebLink
Nv <br /> M COUNTY <br /> Data art for Tank SyIk stem Tighl. ss Test COPY <br /> PLEASE PRINT <br /> 1. OWNER Pmpeny ❑ S fro%u X'90 ()-Z0`Ak IO�I C0 ':!_,4#A1 eH(aaltA+ �1y9J41S•7/f', <br /> Name Address Rapwvnutive T•Nphorr <br /> Tank(s) F1eSAisl& 45 444414- <br /> Nam• Address R•pne•.WIN$ Telephone <br /> 2. OPERATOR <br /> No.. Addr«W. /AAAL4d ,& rd /entre do e.c.A 0i�w?"�2Lt9 <br /> 3. REASON FOR circ r, f s <br /> TEST <br /> (Explain Fully) <br /> 4. WHO REQUESTED T o ��fehse"` r i•Q7 <br /> TEST AND WHEN N'm' Tina ComWnv or <br /> Affiliation9' " D•r / <br /> r>< �e,u� 12'" A e"t". ? 8/3 <br /> Addw TN•pnone <br /> 5. WHO IS PAYING Z1, P t .� �o�isy H.� est v o/traLrr 1Z3J4 33'9/Y'f <br /> FOR THIS TEST? c Ao•ncy or Innv Parton Autnodxing W •teen rte <br /> anon Addren Cln Sur no <br /> Attention of: Order No. OIMr InNuctlone <br /> Identify by Direction Capacity Brand/Supplier Grade Approx.Ape Steal/Fiberglas <br /> 6. TANK(S) INVOLVED 1 fJor-4k0 000 CU 0 1D.r• <br /> eta IY1lddlc 000 TWO ul I e� <br /> 3 doe k 10000 TWO L � S <br /> Location Cover Fills Vents Siphons Pumps <br /> 7. INSTALLATION Fror,4 O{ /t� I <br /> DATA ia� t_,ottIC"-TC, y" Orop 4ube, a If N oY12. Gi��arao� <br /> raano�e <br /> North inside ddvew•v, Concrete,Black Too. Six.,Titefill make,Doo S"cuon,Remote, <br /> Rear of anion,ata IUnit,etc. tube..Remote Fills Size.Manllold•d Which ranks 7 Make if known <br /> 6. UNDERGROUND 1 is the water over the tank? <br /> WATER Depth to the Water table PO <br /> ,,O u•1 Off <br /> t---" ❑ York No ( �j <br /> Tanks to be filled 9• 0 POL, a'01'4-88 Date Arranged by D• i "'t3 �-"' 9l Y <br /> 9. FILL-UP Nam• Wootton• <br /> ARRANGEMENTS Extra product to"top off"and fun TSTT. Now and who to provide? Consider NO Lead. <br /> Terminal or other contact <br /> for notice or inquiry <br /> Company Name �T• none <br /> 10. CONTRACTOR, <br /> MECHANICS, <br /> any other connector <br /> involved d C <br /> 11. OTHER <a tea NS <br /> INFORMATION �\ S <br /> OR REMARKS <br /> Additional information on any items above.Officials at others to be advised when testing is in progress or tomJW.Visitcurs cr observers present <br /> during test etc. <br /> Torts were mads on the aDow tank systema in accordance with test procedures pnacrMad for e►1ro�s <br /> 12. TEST RESULTS as detailed on attached teal charts with results as follows: �BTa <br /> Tank Identification Tight Leakage Indicated Dar Tested <br /> C Alor ulor . /leS 7-, 011C � • Q14• 99 <br /> #a m dt u 0.2 <br /> This is to certify that these tank systems were tested on Use datai shown.Thomas ledlcated u"Tight'meal the criteria established by <br /> 13. CERTIFICATION the National Fire Protection Asoclallon Pamphlet 329. <br /> a- <br /> Qq - gg / aZ Testing Contractor or Company <br /> v N.c�.w�/I E,✓v s <br /> °i' ENVIRONMENTAL LABORATORIES, INC, ey` ""' <br /> )4198 ia4 i ►tea 4/ r( ���82 q 1447 E.Shaw Ave. Suite ISO Fresno, CA93710 <br /> Senal No.of Thermal Tecnn¢ians <br /> sones (109)125.6698 <br />