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CRISP TANK TESTING Tes ` Reoo t <br /> 14U W. AIDER • ----- <br /> STOCKTON, CA 95204 Underground Storage Tank ? <br /> HORNER SYSTEM <br /> OWNER OF SITE <br /> ADDRESS OF OWNER CITY STATE A ZIP Cj521rJ . <br /> OWNER OF TANK <br /> ADDRESS OF OWNER _CITY L c.►, STATE ,-i ZIP 5-0 <br /> NAME OF OPERATOR AT LOCATION <br /> ADDRESS OF LOCATION > >�% �; M��.v �T. CITY I- STATE 'il ZIP c(S-2�Fo <br /> NAME OF COUNTY <br /> TANK # �Nr_" ON PLOT PLAN LOCATION. STORAGE SYSTFM FILLED: DATE )' / '-.'ETIME -%;ct� <br /> DATE OF TEST V- /q-S , TIME OF DAY: START 0.�' FINISH <br /> y�_ <br /> LENGTH OF TEST h AIR TEMPERATURE -1.2 <br /> DISCRIPTION OF TANK-CAPACITY DIAMETER METAL FIBERGLASS _ <br /> TYPE OF SYSTEM- SUCTION_ X SUBMERSIBLE OTHER <br /> TYPE OF VAPOR RECOVERY SYSTEM 1NCNt — <br /> TYPE OF PRODUCT BEING TESTED Lily EASRURED GRAVITY ; L, COEFFI C I ENT. 00c66- <br /> TEMPERATURE OF PRODUCT // <br /> MEASURED WATER IN TANK - �, -- DEPTH OF TANK TOP FROM GROUND LEVEL <br /> DEPTH OF GROUND WATER ; _20' HEIGHT OF LIQUID LEVEL IN TEST STAND OR STAND PIPE ;. <br /> AGE OF TANK AND LINES C-M <br /> RESULTS OF TEST: CERTIFIED TIGHT: YES__�_NO IF NO EXPLAIN D RKS BELOW <br /> LEAK RATE PER HOUR: <br /> REMARKS BY OPERATOR <br /> ROrtnE.N'TAL h-ALtH <br /> �i <br /> NAME OF OPERATOR <br /> SIGNATURE OF OPERATOR// �/ i�1'clL C <br /> DATE <br />