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IIII III f Champion <br />iPrecidon Tank Testing <br />L.Icen No. 73848 <br />0 <br />P.O. Box 13069 <br />HORNER EZY-CHECK CERTIFICATION <br />Sa &e nto, CA 95813-3059 <br />CA 800-660-9443 <br />NEV 800-949-9443 <br />(916) 927.1557 <br />Fax: (916) 927-7345 <br />Name & Locati9n of Company <br />Company • Phone_(_) <br />__.C_ State Zip <br />NOTICE TO OWNER(s)l A COPY OF THIS TEST RESULT HAS BEEN FILED WITH THE PROPER REGULATORY AGENCY, <br />WHICH IS REASON FOR TESTWG <br />'NOTICE' IT IS THE RESPONSIBILITY OF THE OWNER(S) TO CONTACT THE LOCAL ENV. HEALTH DEPT., IN <br />His / HER AREA OF ANY TANK. FAILURES WITH (24) HOURS. . <br />Who reauested When? <br />Identify by LD <br />Product <br />Capacity Apx Age Steel Fiberglass Brand/Supplier <br /># l <br />zx 2 <br />9i7 ti I-- <br />DATestedID# <br />t7 N ❑ <br />Y [91(1 ❑ <br />e6 z 3 <br />7,a <br />—11 <br />Y 9-N ❑ <br />Y t9�N ❑ <br />ec / 73 <br />Y N D <br />Y N D <br />— <br />— az Time: .1 <br />Comments <br />REPRESENTATvE(S) OR OMER(S) VYLL BE NOTIFIED V&EN THE TEST HAS BEEN COMPLETED AND ONE OFFICIAL MUST BE PRESENT DLRNG <br />THE TESTING. ALL TESTS MADE ON TIE TA W(S) SYSTEMS ARE VALD THE FIORPER-EZY CHEK LEAK DETECTION PROCEDURES. <br />THIS CERTIFICATION sHo%vS THE CwERIA ESTABLISHED BYTE NATIONAL FRE Assoc. (PHAMPLEr 329). <br />va/1 .iP1 rA' Vonnr Pacnuary SVStBrt1 C/Vent Lines) K/' <br />rest reesutu mcluue <br />Tank <br />I <br />Tight <br />Tank <br />Tight <br />Lines <br />Leak/Per Hr. <br />Ind. TankDetected <br />- <br />Leak/Per Hr. <br />Line/Y <br />DATestedID# <br />t7 N ❑ <br />Y [91(1 ❑ <br />e6 z 3 <br />7,a <br />—11 <br />Y 9-N ❑ <br />Y t9�N ❑ <br />ec / 73 <br />Y N D <br />Y N D <br />Y ❑ N ❑ <br />Y ❑ N ❑ <br />Technician: 4N ) &J Certification #: 9y— iy r <br />