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Champion P.O. Bore 13059 <br /> Sacramento, CA 95813-3059 <br /> Precision Tank Tes[in-9 CA 800-6640-9443 <br /> L1cancr No. 73.848 NEV 800-949-4443 <br /> (975) 927.1557 <br /> Fax: (916) 927-7345 <br /> HORNER EZY-CHECK CERTIFICATION <br /> Owners Property Tanks(s) <br /> Compan rGN c=,'}fit ��c a<}1 , Phone_L� <br /> Address <br /> City 5 State _ zip <br /> Name & Location of Company <br /> Company P:)One^c---) <br /> Address <br /> City State i p� <br /> NOTICE TO OWNERS)l A COPY OF THIS TEST RESULT HAS BEEN FILED WITH THE PROPER REGULATORY AGENCY, <br /> WHICH IS REASON FOR TESTING <br /> `NOTICE' IT 1S THE RESPONSIBILITY OF THE OMER(S)TO CONTACT THE LOCAL ENv. HEALTH DEPT.,IN <br /> HIS/HER F.REA OF N,.,y ThtiK FAILURES WITH(24)HouRS. <br /> Who requested When? <br /> Identify by I D Product Capacity Apx- Age Steel Fiberglass Brand/Supplier <br /> j5ti I—N L xsA bt v C <br /> Tanks to be filled Date. 3 - �'-`i Time: <br /> Distributor 0-5 Extra Product tc to off a <br /> Comments <br /> REP RESENTAT!v_(S)OR CYUNSR(S)WILL 5E N0 1=1EC YdHEN??dE i LST iIAS BEEN COMPL--'17f=D AND 014E OFFICIAL IAtj1S^r BE PRESENS D'JRING <br /> THE TESTIN=G. Al L TES S N,ADE oN THE TAt4L1(5)S'S--t.'S ARE VALl:)--IE HORN=R-EZ"CHEK LEAK DE rECT10N PROCEDURES. <br /> THIS CERTiFIC.ATION SHOWS THE CRi ERIA IES',A5Llz4EC @Y Tr1E NATio%,\L FIRE Assoc.{P-AMPLET 3291. <br /> Test Results Include Tank(s) ©'!_lne(s) P"'Vapor Recovery System El Vent Line(s) CSS <br /> Tank ;Ta <br /> ght Tight Leak/Per Hr. LeakfPer Hr. :Date Tested <br /> IDS nk LinesInd. Tank Detected Line <br /> 17r 5�Z ErN ❑ Y N ❑ <br /> CtNLir.4Pep Y (�N ❑ Y R N ❑ c>-3/.I -,oix � -� - ` 7 <br /> r--r-r i <br /> &4NLC14a�D <br /> SL)Lc.tf-r Y eN ❑ Y Lr/N ❑ 4-.crate 3� 7 <br /> Y N Y a N <br /> n n <br /> Technician: J '.t. 1 �<�- Certification 4' <br />