Laserfiche WebLink
sp ank T+�sl, � <br /> ` 4pCoinpuny <br /> Phahb (209) 9311-426 <br /> ,Pod UNIC6 Box 30481 ENVIRONMENTAL HEALTH Ur.prrspd <br /> 'Sfoc#doM, CdIllornld 45213 <br /> �s PERMIT/SERVICES , SL-,-NSE #92-12.4��'sured <br /> {E <br /> "'I'[' 'I' rtt;t'rltt'I' ► �.F0t'lA"D E. CRISP <br /> OWNER OF SITE t � <br /> - <br /> OWNER OF 'TANKS t <br /> ADDRESS t ---- --- <br /> '� CI'T'Y ; 7, I1' r <br /> OPERATOR ATLOCATION r �-� <br /> ADDRESSe <br /> IT y <br /> COUNTY11 f` TANK <br /> METAL( ) . t:I tar R(;J.,ASS <br /> 00111.11,F <br /> DIESEL(/Y) UIMEADEU( } t'CrI,FIl.tJbl tJrar,t nlrrt7( } <br /> • WASTE OIL( } I�I;t�c�sEnrr,( ) nvrATT c�ry fl,AF; l rr; !' r tl +.,hrr.rx .i ) <br /> SUCTION("Y,) SUBMERS11ILr( ) rrvr:trt,r' rr,+, r rrrtrntrrrr2 _Yr;;1 ) F1t) ) <br /> SllEAR'=VALVE-.-Y Es( ) No( ( �` } <br /> 1�) [N_..q�rrft; t��;nl; �er; t•I:r.,tr�it--Y <br /> VAPOR RECOVErtY 8YS'rEtl__Yr,s( <br /> If. Yl;.; , ( I ) ) NO(K) ' <br /> ) <br /> TANIt ' C'ILL bA,rEz ( <br /> t 9- {�- �'t'.[F1r• ; �9 - <br /> TANK TEs,r D.krE: �- --- <br /> TANK SO'CTOM -� s'rAtr'r: _VNtr; DpG7�r,►.nrr;'rr# UC 'rr.,'r , � <br /> TO . GIRAVE. . . . � 1.1 - - . <br /> TANK "Cap TO GstAt�E. , . , . . ��- �� TO TANK 110,1"f Util <br /> r.lrr�ttrtla 1111`1'1?fr AIJOVE 'TANK . . <br /> biAME`rER. � � � � . . . , s , � . . . . g3 <br /> TEST LEVEL AnovE CROUN#). _f T 1 , 1 . . . . . . . . . . . . . . . . . . . . . �� <br /> NET 'r t :; r I ft r; <br /> HATER IN TANK � t►trr <br /> DEPTH FOR TAKINd SApipLl; .� .J hl' r :;r'r.c` r:+jhv , ., � 3,5 <br /> TEMPER — 't'r,f t l . . . . . . . . . . . . . . . . . . . . <br /> TEMPERATURE I'ROI3E bEI''l'ii I 70 <br /> _._ <br /> f;I?AV n f- <br /> . <br /> t'.ERTIFIEO 1'111.11 r I rfl'r' r►t E!�t' . . . . . . ' <br /> r.I;At, tinrl 1111/ttt� . I _ /_� <br /> PRObWOT LINE TEs`r--pAss('k) r h t t,( ) = t1r:'r t (IN(X) 11 R ESst1R E <br /> CERTIPIEb TIUIIT--YES( ) NO( ) ( } <br /> t,r.ht: 12ATF. <br /> DAT8 l <br /> SIGNA'I'11I2r ()1 <br /> COMMENTS <br /> 4 <br /> REV 3/92 -- -------�� <br /> r <br />