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i <br /> CRISP TANK TES ING <br /> 2004 Piccoli #9 (209)931-1828 <br /> Stockton, Ca 95205 <br /> TEST REPORT <br /> OWNER OF SITE t'�a�c��1�_►f� _• <br /> ADDRESSCITY STATE ZI <br /> OWNER OF TANKS / — _ <br /> ADDRESS 330CITY STATEZIPC� <br /> OPERATOR AT LOCATION ails <br /> ADDRESS ' k0a in ITY STATE, ZIfCl,-jZ <br /> 1 <br /> NAME OF COUNTY t O f�� <br /> TANK ON PLOT PLAN. <br /> DESCRIPTION OF TANK: <br /> CAPACITYGl ,DIAMETER , METAL FIBERGLASS ,AGE <br /> TYPE OF SYSTEM: SUCTION_: SUBMERSIBLE OTHER <br /> VAPOR RECOVERY SYSTEM? - ; TYPE <br /> PRODUCT BEING TESTED MEASURED GRAVITY ], <br /> COEFFICIENT _. TEMPERATURE OF PRODUCT`' _, AIR <br /> STORAGE YSTEEM: <br /> ILLED - DATE 3--/L3-$�' , TIME 1300 <br /> TESTED - DATE - _, START /5r , FINISH_���_• <br /> LENGTH OF TEST rrx I nS , <br /> MEASURED WATER IN TANKHEIGHT OF LIQUID LEVEL <br /> DEPTH OF GROUND WATER ' �• PSI AT TANK BOTTOM <br /> RESULTS OF TEST: <br /> CERTIFIED TIGHT? - YES X ; NO IF NO EXPLAIN IN REMARKS. <br /> LEAK RATE PER HOUR: + or <br /> REMARKS BY OPERATOR <br /> NAME OF OPERATOR L c <br /> SIGNATURE OF OPERATO d 7 <br /> DATE 3 14-& U <br /> MBAR 15 19 <br /> ENVIROMENTAL HEALTH <br /> F ERIM 11/SERVICES <br />