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Sacramento Equipment Maintenance Company Inc <br /> 2533 Connie Drive Cara.Contr.ucanso x5oz3T7 <br /> Sacramento, CA 95815 Wo#38215 <br /> PLFAS 9RINT 5 Data Chart for Tank System Tightness Test &affirm 1/474 <br /> PLEASE PRINT <br /> 1. OWNER Pmbry❑ lie Caldwell <br /> TweNl❑ Noma Aderw N•pr••breve <br /> (2 0 9 Jai-0241 <br /> Mina Aderw RpnbnbrM TalpMrrk <br /> 2. OPERATOR 209 463-7716 <br /> Wine Abbe TNapheM <br /> 3. REASON FOR <br /> TEST County Permits <br /> (Explain Fully) _- <br /> 4. WHO REQUESTED <br /> TEST AND WHEN "'"" Yale Qomp.rrymAnulban� Dab <br /> Aderw Tsrpterw <br /> kkertlry by Olndkm Gyaoay abM/aumiler Grade Apprec Age NMIIFIbraIW <br /> 5. TANK INVOLVED )i 10 ()()n 474-1 Prprnillrn 1 Q61 <br /> '56If 10,000 474-2 Unleaded 1961 <br /> for maMladM a0aldedllnb roars h, • 10,000 474-3 Regular 1961 <br /> Ter <br /> I.ocsnm Co. Fells Venue tkdwnb Pump <br /> 6. DATA INSTALLATION NM7-11 OF 4/// p Gtr y✓L <br /> �11✓(r' 07 Ov() Sr� <br /> North bode bMwry. Concrwa.BI Nza.mune make,OrkP audiorr,aarre4 <br /> Rau of wttan,MC a MOA.Wmota loot 8h0f.WnlbkfW Whildn tanks? Nsks Y mown <br /> 7. UNDERGROUND rbwtlwewa�kheTWtl <br /> WATER DpNbaw wNw rsr AlEclzS irycJl �di.1T Fly. 40ma <br /> 8. FILL-UP TWbbb NMJ_M. MA AnaresdM Name, Tailor. <br /> ARRANGEMENTS Enra po0uc1 b1Pp oTand rm boar tbr. lbw and wtb No Provide?Consider NO ta.a <br /> b <br /> Tnothb eouc mONbwYpd, <br /> DarrrOsny Nrrra TNpkpla <br /> 9. CONTRACTOR, <br /> MECHANICS, <br /> any other contractor <br /> Involved <br /> 10. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> AOdalonal bbrrbtbn m enY Mwb Inoue OmtlYs or dheb b b adr4ed wirer IINkN la In proprab w aenrptNad.VYllm m obsarvsn Prbwa sump r0.std <br /> 11. TEST RESULTS Tests were made on the above tank systems In accordance with test procedures prescribed for <br /> as detailed on attached test charts with results as follows: <br /> Year Idsntlaollon We tbklas IndlnlsE Data Tbbd <br /> A74-2 <br /> 47 —3 Rpaular <br /> 12. SENSOR 13.This Is to certify that these tank systems were tested on the date(s)shown.Than Indicated as"Tight"meet the edteda established by <br /> CERTIFICATION the National Fire Protection Association Pamphlet 329. <br /> Tkde id•k• Ilrethe resporeibility of be owrreraMlw operator ai ails syNem bimmedletety etivbe fide erM armee autherltieedarry <br /> / Implied hazard are the possibility deny rupotalve pollution W to wnienment b a mina d the indemoul failure d bb <br /> �• `-�-' � system.Neah Consuftenisl <br /> rkpporNed aMla SACMMENTO EOIAPMENT MAINTENANCE COMPANY,INC.fires out <br /> assume any responsibility or liability f!;pylum of product to the ami ment. <br /> 11Md ND.Or T,wma ounces"1 <br /> Saviour <br /> a Ll/iY>/l��SSq <br /> CwthMathm e ew } U`- Tank Owner/Opine Date <br /> 101 <br />