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0 0 <br />III III Champion P.O. Box 13059 <br />Sacramento CA 95813-3059 <br />Precision Tank Testing CA 800-660-9443 <br />v� License No. 73848 NV 800-949-9443 <br />1-916-927-1557 <br />USTest 2000/P Fax: (916) 927-7345 <br />PRECISION TANK TEST(S) EVALUATION REPORT <br />111E US Test 2000 System declares a tank to be leaking when the measured leak rate "cocils the threshold of .05 gph and has a probability of false <br />alarm of <l% and a probability of detection ot> 99%. Champion assumes no responsibility for product leakage. Our responsibility extends only to <br />the testing of tanks as to tight or not tight, as of the date and levels tested. <br />Date: 1 _11%-a l <br />Site ID: Pxx�63a <br />Operator: sVVV>� f=�CXON <br />Site Address: EA T ml 1T <br />City: TO" \I State: > On Job Site Time: 0Zc�c3 <br />Zip: Pltonc!adQ - 14 4 - 9;-O, Off Job Site Time: 1 300 <br />TEST TEST <br />LEVEL RESULTS <br />1.%5% 01005 +- Pass XFail ❑ <br />2. % Pass ❑ Fail ❑ <br />3. % Pass ❑ Fail ❑ <br />4. % Pass ❑ Fail ❑ <br />TEST TEST <br />ULLAGE RESULTS <br />I. 15 % tN dr, Pass Fail ❑ <br />2. % Pass ❑ Fail ❑ <br />3. % Pass ❑ Fail ❑ <br />4. % Pass ❑ Fail ❑ <br />LINE TEST RESULTS <br />1. 2. 3. <br />DIAMETER <br />LINE LEAK DETECTOR <br />VOLUME <br />1. Pressure Suction <br />❑ -OJi5 <br />Pass AFail <br />❑ <br />�D L <br />y� <br />Pass X Fail ❑ <br />2. Pressure ❑ Suction <br />❑ <br />Pass ❑ Fail <br />❑ <br />2. <br />Pass ❑ Fail ❑ <br />3. Pressure ❑ Suction <br />❑ <br />Pass ❑ Fail <br />❑ <br />3. <br />Pass ❑ Fail ❑ <br />4. Pressure ❑ Suction <br />❑ <br />Pass ❑ Fail <br />❑ <br />4. <br />Pass ❑ Fail ❑ <br />TANK INFORMATION <br />TANK # <br />1. 2. 3. <br />DIAMETER <br />20 - 36 hours <br />VOLUME <br />�5 _ <br />PRODUCT <br />-N -(-)NL <br />TANK TYPE <br />=7 <br />PROD LEVEL <br />_ <br />DIFF/ VOL <br />S ra <br />WATER IN TANK $ <br />WELL POINT <br />GRND WATER nT <br />Amount of Product Wait Time Before Precision <br />4. To Be Delivered <br />Tank Test <br />_ 75%-90% <br />20 - 36 hours <br />_ 50%-75% <br />14 - 20 hours <br />_ 25%-50% <br />8-14 Items <br />5%-25% <br />6 - 8 hours <br />_ <br />Amount o_f Last Dclive <br />_ "/o of Tank Ca ci - Time - Date <br />_ <br />_ Tank 1 2-lOa <br />14S hm 1.21=01 <br />_ Tank 2 <br />_ <br />_ Tank 3 <br />Tank 4 <br />Minimum Test Time From Differential Volume Chart -(Min.) Tank 1: %O Tank 2: <br />COMMENTS: <br />Tank 3: Tank 4: <br />Any additional tank testing infomtation requested by your office is on file at Champion Precision Tank Testing. Fuel delivery slips are <br />on file with Tank Owner. 1 <br />TECHNICIAN: William Campbell CA - LIC. 98-1324 - SIGNATURE.6 Xk-� DATO -26 -qi <br />