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TlNJK '�" <br /> P.'O. BOX 30487 <br /> Stockton , Cali fornix <br /> (209) 931-1828 <br /> 'I EST Fziar�©rzT <br /> 0WI)FR (IV SIIEt <br /> ADDRESS -kal 4y r <br /> � � CITY <br /> STATEZIPy � <br /> OWNER OF TANKS <br /> ADDRESS <br /> CITY STATE ZIP <br /> IFERATOR AT LOCATIUPJ <br /> ADDRESS <br /> 71-46 ' f CITY <br /> NAME OF COU14TY 5TAIE.(, ZIpy � <br /> TANK # UIJ PLOT PLAN. AGE OF TntJ]K <br /> DESCRIPTIOrJ OF TANK: <br /> CAPACITY - �Q �, Z13- 7A <br /> __r�T ,OIAMETEII MITAL--X FIDERGLASS <br /> TYPE OF SYS1EIl: SUCTIUIJ : SLUMERSIDLEZ <br /> VAPOR RECOVERY SYSI EI•I d OTHER <br /> � ; TYPE " <br /> T'TZODUCT BEING 1E51[:D ` M hSURED GTtAVITY <br /> API SPECIETC GRAVITY fel 0 =`� 1. r- �• <br /> 6 f] qD U C T . T E M I�.G C 0'�-r-- <br /> STMAGE �S�sT �4: _y <br /> DATE , T 1 I1F- J <br /> TESTED - DAIF-. ,' J c <br /> LENGTH OF TEST FINISH 2y� <br /> MCASMED WATER III IAIIIC_ <br /> DEPTH OF GROUND WhIER IIrIGIiT OF t_I UIU LEVEL <br /> PSI AT TANK BOTTOM <br /> RESULTS OF TEST: <br /> CER TIFIEaI) TIG1117 - YES ` <br /> NO IF 110 EXPLAIN 1N REMARKS. <br /> LEAK RATE PER HOUR: + � or _ t_. <br /> RFMARKS DY OPERA I OR <br /> Awr <br /> NAME OF OPERATOR <br /> SIGNATUrTE OF OPERATOR <br /> DATE —( ��. i <br />