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9 4 <br /> OWNER OF SITE <br /> CRISP TANK TESTING — <br /> 140 W. ALDER d 1 < i I , <br /> STOCKTON, CA 95204 HORNER EASY TESTING METHOD ADDRESS <br /> WORKSHEET; Y fG 5 . CITY-STATE•ZIP CODE <br /> OWNER OF TANKS <br /> TANK No. TEST LEVEL/L PRODUCT "' CAPACITY a SAO CHART CAL r ` _ . • 703 (A) <br /> MEASURED GRAVITY 3 n:-- PRODUCTTEMP Ll COEFFICIENT ADDRESS <br /> TEMP CAL. !7 '>!J �'^. � � / � IBI <br /> LEVEL LEVEL GAIN x(A) LEVEL TEMP. TEMP. GAIN♦ x(D) TEMP. FINAL w f CITY-STATE.ZIP CODE <br /> START END LOSS— x(A) RESULT START END LOSS— x(B) RESULT RESULT TIME <br /> �1 / �yy L /� { O N <br /> '0 U` x • yam J)i� �y s / / J �7 � ` '✓ ,� x i J + !J 7 s OBJ a OPERATORS NAME AT SITE <br /> a <br /> .� _ ✓ x. .��. rx TYPE OF SYSTEM <br /> ❑SUBMERGE ®SUCTION <br /> X. ,A O x ! LENGTH OF COLOR CODE OF PRODUCT <br /> / r <br /> S9 �� �OQ 7 O ' . �7 . r FILL PIPE <br /> ' + n �i CLEAR ORANGE <br /> RED <br /> DIAMETER <br /> 7 x • J D -� O.v •7 Off'. •`+ Q 7 C x• /D D ' 0/f-� ' / G ;1 "'�'' DIAMETER OF TANK METAL - <br /> ! T J • i ! 1 J Os <br /> ❑ F16ERGL/L551 <br /> xxTYPE OF RECOVERY SYSTEMZ Vn0U <br /> r ❑BALANCE <br /> RED JACKET ❑HEALEY <br /> Z ✓ /9� f7 s Q I ^ WATER LEVEL IN TANK <br /> x 9 . 43gq - x . / — o r <br /> DEPTH OF GROUNDWATER (IF KNOWN) <br /> /} _. <br /> DATE/TIME STORAGE SYSTEM FILLED <br /> DATE TIME <br /> STATION LOCATION — y _ L CERTIFIEDTIGHT - Y <br /> _ AGE OF TANKS <br /> ADDRESS - - - %'" LEAK RATE PER HOUR f�0 <br /> j <br /> CITY STATE OPERATOR �= " '' AGE OF LINES <br /> DATE = SIGNATURE <br /> _ TESTING FLUID.IF DIFFERENT THAN <br /> STORED MATERIAL <br />