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ORISP TANK <br /> P .•O. BOX 30487 <br /> SL6 , ton , California <br /> . (209) 931-1828 <br /> `t"L.5T REPORT <br /> [nJr tE R or SITEck <br /> 5 -CJ �1 <br /> ADDRESS CITY oSTATE ZIPgS <br /> ---� <br /> OWrJER OF TANKSG�' �- � C. 'S <br /> ADDRESS Ca <br /> CITY STATR2,6� Zip. <br /> OPERATOR AT LOCATIOrJ <br /> ADDRESS Co ? (e "? �` t CITY <br /> NAME OF COUIJTYCcy� STATfZIPg S <br /> TArJI< .- �y 014 PLOT PLAN. AGE OF TANK <br /> DESCRIPTION OF TANK: <br /> CAPACITY 20© O ,DIAMETER METAL FIBERGLASS <br /> TYPE OF SYSTEM: SUCTIO142 SL13MERSIBLE OTHER <br /> # VAPOR RECOVERY SYSTEM? iV c� ; TYPE • <br /> PRODUCT BEING TESTED i L�C7MP-Y> COE <br /> STORAGE PI <br /> MEASURED GRAVITY <br /> API SPECIFIC GRAVITY A 60oF_�j(. -'-pt�OD <br /> $ ' <br /> Y Erb . TE <br /> 5 <br /> �TEIj'- DATE - TIME <br /> % - - - <br /> ME <br /> TESTED - QA TE r - g 9 2, START C> -� FINISH <br /> LENGTH OF TEST • <br /> MEASURED WRIER I14 TANK <br /> HEIGHT OF LIQUID LEVEL <br /> DEPTH OF GROUND WATER PSI AT TANK BOTTOM <br /> 6 <br /> RESULTS OF TES[: <br /> CERTIFIED TIG11T7 - YES NO <br /> LEAK RATE PER FOUR: + ; <br /> or IF NO EXPLAIN IN REMARKS. <br /> REMARKS BY OPERATOR <br /> NAME OF OPERATOR - <br /> fS <br /> SIGNATME OF OPERATOR a <br />