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COMP MIX TESTING • • <br />P. 0. BOX 30487 LICENSE X92-1248 <br />STOCK10a, CA 95213 <br />f209) 931.1/823 ` LEONARD E. CRISP <br />TEST REPOP.'r <br />OWN" OF SITE—Im leaf ]) <br />ADDRFSS) -? �, ICI'1'Y ' _ ZIP <br />OWNER OF TANK(S)_,:SaMF ae �L�II\lf <br />ADDRESS CITY <br />7..IP <br />OPERA'T'OR AT I,OCATION-11�1'> FXX()n _ <br />ADDRESSja-jj C. CITY n, CALIF. ZIPqt) <br />NAME OF COUN'T'Y ��n n C . <br />TANK4k­L_ON PLOT PLAN. AGE OF TANK1_YRS. CAPACITY._bD GALLONS. <br />DIESEL, PREMIUM UNLFAUED_, UNLEADED_, REGULAR_, <br />KEROSENE , 0111IIER <br />METAL,X_FIBERGLASS_ VAPOR RECOVERY SYS'T'EM: YES _N0.,k, <br />TYPE OF SYS'1'EPI: SUCTION, SUBMERSIBLE_, OTHER <br />MEASURED APT SPECIFIC GRAVTTY,32,_. PRODUCT TEMPERATURE , <br />API SPECIFIC GRAVITY @60' F,31d. <br />COEFFICIENT OF EXPANSION ,OD0949gs: <br />TANK FILLED - DATE -0-," TIFIE <br />TANK TES'T'ED - DA'L'E - D STAR_ FINISH_ <br />LENGTH OF TESTA. <br />TANK BO'I"COM TO GRADE TANK 'COP TO GRADE '. <br />DIAMETER 14V . TEST' LEVEL ABOVE GRADE). WATER IN TANK �1 /� <br />DEPT11 FOR 'CAKING SAMPLE. 'TEMP. PROBE DEPTH). <br />TEST LEVEL TO TANK BOT'T'OM). GROUNDWATER ABOVE TANK. <br />PRODUCT PRESSURE per 1" IIFIGHT ,LogPSI. /1.600L <br />**RESULT'S OF TEST** <br />CERTIFIED 'TIGHT: YES -X -NO <br />LEAK *2—w—f <br />RTE, PER HOUR: + _ O� Q:O <br />SIGNATURE OF oPEP,A'TOR__; NAME .4zR(l( 2 <br />G'— <br />r�Q` p <br />