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(, G3 6y 9 t first hour Jr353 OWNER D.E. SITE: <br /> � CRISP TANK TESTING last hour _ <br /> 2004 Piccoli Rd. #9 ?R �D SD i 5tj 5!3 I J9 GJ �P✓ l a ! ,r - <br /> Stockton, CA 95205 f; �3 HORNER EASY TESTING METHOD ,G / Q ADDRESS: <br /> F , <br /> MAY 1 WORK SHEET IT.Y-TYTE-ZIP: <br /> CHART CALIBRATIONS (A) <br /> le <br /> ENVIROMENTAL HEALTH 4'y 2 <br /> TANK#d2h .TEST LEVEL ERt }T/SER`JR6&CT CAPACITY4000 - first hr, O )_� + 'r) =002. WNER. OF TANKS: ' <br /> last hr, U +Lys= UO ADDRESS: e. <br /> MEASURED GRAVITY PRODUCT TEMP�LAIR _COEFFICIENT aTEMP CAL, OOO�V4`q°I X = (g)'I S <br /> TESTLEVEL .LEVEL GAIN+ LEVEL TEMP . TEMP: N+ X(B TEMP: FINAL <br /> NO- START END LOSS- X A RESULT START END LOST- X(9) RESULT RESULT TIME CITY-STATE-ZIP : <br /> = o <br /> l - 80= X, oo s o a` _ �d_. 00 X3. <br /> SDG 0 7 0 3 ! GRADE TO TANK BOTTOM:/3a` <br /> ` X = _ X = t 0F;� A DIAMETER OF TANK : 93� <br /> t 00 c� D !) U 0� 0 3,50(�� . 003-5c> 83- LENGTH OF FILL PIPE : 39 <br /> 1 _ <br /> X X_ - _ - 0 837 GROUND WATER DEPTH <br /> c��y )4 <br /> 0 / / () Da �` O D . D. 3 ,50641 603.50OU 0 59, HIGHTH OF LIQUID LEVEL <br /> C) )gqs WHILE TESTING :/5'54 <br /> CX _ <br /> l 7 4• 1 X a O R-.500 �� U , ,2 D �- •0� 064 . c7/6.5-/ .` <br /> D/ U U 7 VAPOR RECOVERY SYSTEM: <br /> &CI (x). YES ( ) NO <br /> X. 0D � UD 3. X <br /> LEE- ZERLMC�p <br /> O5o6cl . 06 e010 3 0 SYSTEM TYPE: <br /> X - _ - X. _ 0 qaa' (.-AOTHESUBMERGE () SUCTIDN <br /> • �� 75O6 'l.C)D 3, 5 06V 0 D D D � �. TANK TYPE: . (�) METAL <br /> _ _ �y __ _ _ Oc/37 <br /> rJ � - L/ X. odl � v6 S� rOD 3. }UG�L - dU`? U� �70� 0 ( ) FIBERGLASS <br /> COLOR CODE OF- PRODUCT: <br /> CLEAR ( ) RED <br /> 7S �.�' X, )U !7 �O . 'f i7(} 3,5 DGrL ' 000/ 1. 0070/ <br /> t3 / ( ) ORANGE <br /> J/ AGE .OF TANKS' <br /> : <br /> 11 I h a ~ Or 6-,) Y wJc� Ch LEAK RATE PER HOUR + _ , r AGE OF LINES: ? <br /> TANK LOCATION 1 n 3 �a� � - <br /> ADDRESS `" 0 (4-2 \/ 0 $ P h+ tP. PASS ( `FAIL ( ) INCONCLUSIVE ( 1 STORAGE SYSTEM FILLED: . <br /> i ( i< ei0 /lc7Y � t C.1^ 1 S j <br /> DATE:-,/F &F <br /> CITY V) 1 h TP L 1 STATE OPERATOR TESTING FLUID IF DIFFEREN' <br /> THAN STORED MATERIAL: <br /> DATE L4 — t —� SIGNATURE <br />