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Sacramento Equipment M•�tenance Company Inc • �� <br /> 2533 Connie Drive Calif.Contr. License#502377 <br /> Sacramento, CA 95815 <br /> (916) 925-2716 w0 a <br /> PLEASE PRINT Data Chart for Tank System Tightness Test Station if !/7y <br /> 1. OWNER Fnpoh E] _ _ q <br /> 2 s <br /> Tariffs)El N' Q_( a.a umm TNphdy <br /> Narts AOOr.r aaprs.snlaiM TNepMrt. <br /> 2. OPERATOR " otio - c16-3— 77/ <br /> Nam• Address TNpMru <br /> 3. REASON FOR rz, ori <br /> TEST <br /> (Explain Fully) <br /> 4. WHO REQUESTED 2 <br /> TEST AND WHEN alley rnY Carefully Anuwbn DN• <br /> Address T.Nplwy <br /> entify by Direction Cedty enol/Supow Orad. Approx.Act• W.N/FlMrpbn <br /> 5. TANKINVOLVED Identify <br /> W additional lino <br /> for manlfoi tanks <br /> LOGtlon Goer V•nb splens, NMnp. <br /> 6. INSTALLATION <br /> DATA <br /> Nob rade.a. comm•.eI.A TOP. n.,These fees.Orap auc, awrplA <br /> R..d Ne EeM,Ne bpm,Amon Fos dte,Mneob.d w1acN bneet NY..em'.MI <br /> 7. UNDERGROUND 1s IM.ai.esu be pari <br /> WATER ppb b M wabr Yds <br /> ❑v. ❑Nu <br /> 8. FILL-UP TaNubb.NAd N. Drs Arranged say <br /> Nrtw <br /> ARRANGEMENTS Extra product b 1ep olr erM of who bele. NOW arae of brod <br /> pat Celniesr ND Load. TNepl,orf <br /> Terminal.ob.forted <br /> for eotln or npry <br /> co erany Ilsnr TN.dwns <br /> 9. CONTRACTOR, <br /> MECHANICS, <br /> any other contractor <br /> 1nAti <br /> 10. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> AddkbtY nbrmaibn M aM sena above.Olecle4 d a1Mn b M adrbsd Y b proprer.osrltpisbd.Wears.ab..wn <br /> prewa!NW bot.ala <br /> 11. TEST RESULTS Tests were made on the above tank systems�� n."with test preeedures prescribed for <br /> u detailed on attached teseutts u follows: <br /> AN boor cion TiW tea indicated Dat•Ta.t.d <br /> 12. SENSOR 13.This Is to IxRity that then tank systems were tested on the dale(s)shown.Thou Indlested as'Tight"meet the criteria established by <br /> CERTIFICATION the National Fin Protection Association Pamphlet 329. <br /> T.d"woi^a f 4 ft responsibility of the owner and la operator d by aretam for Immediately advlae arab and local authorities of any <br /> Dai• mplbd bourn And tae Possibility Of any nportabb d th <br /> Pollution ro m•environment u a result e indicted failure of this <br /> 1. "M least CONSMMIS lnppPor fq/or SACRAMENTO E0111PMENT MAINTENANCE COMPANY,INC.does not <br /> MrW No.elTMrmY C.eso.0 a 4// 1 assume any n apd Boboosibllay ' for Any sus of product to be environment. <br /> o ��� (L- <br /> teneor <br /> C.reentlatl Y��0���03y1J Tank Ownarl Operator <br /> Date <br /> tot <br />