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Sacramento Equipment Mailenance Company Inc • <br /> X1533 Connie Drive Calif.Comr.License x602377 <br /> Sacramento, CA 95815 woo 54030 <br /> (916) ,6 <br /> PLEASE PRINT Data Chart for Tank System Tightness Test Station 111 1334 <br /> PRINT <br /> 1. OWNER property Circle K Corp. - Environmental Dept. - 3��4e3em7 Myrtle Ave. Suite 44.0 <br /> Tank(#) Nan" North Highlands, ta. 9 660 CraigMr enter 916 -2540 <br /> No" Address - Reprimands"" elaphons <br /> Store 1 4 - 26 0 Mt. Diablo St. Stockton - Ca. 209 465-4 63 <br /> 2. OPERATOR <br /> . . Nacre Adelman n Tmeyhbla <br /> 3. REASON FOR s stem inteigpity -' <br /> TEST <br /> (Explain Fully) ,. <br /> 4. WHO REQUESTED same as #1 <br /> TEST AND WHEN Nae The _ t:aro.m«Amllmm oma <br /> Aldrae Tmsptwre <br /> Identify by Direction Capacity BnMAiuppll Orad. Approa. s 81"Mma"Ns <br /> 5. TANK INVOLVED a <br /> the additional Mines <br /> for mandolded tanks _ <br /> LOution COMr Fnh Verde, &pMrYa Pumps-, <br /> 6. INSTALLATION V" e� 4,-/ j L 010, <br /> DATA <br /> No N4 arkawsy, COMM0.Black Top. Sae.Tllma make.Drop Buctbn,Rereb. <br /> Mer W ablwn Na Earth.me lube.femme FM Bza.NnMkNO which tanks? Abka a known <br /> 7. UNDERGROUND . �3 �� r � 7 <br /> WATER Depth to to TMs,Inas, �r« Wa1p <br /> B. FILL-UP Tanker be VAW N._ Data Ammiby samy Tmapwna <br /> ARRANGEMENTS Emn prodanId�op oP and nm tank Mix. lbw wId wfe bpraldsT DpWdtrM - - <br /> 1 I <br /> Tmminm wooer onntael _ - 11r <br /> F ll ^i•-:;i(.,;' <br /> for mom kle" .. _ !I<" Telegenic" <br /> „V.`. <br /> 9. CONTRACTOR, <br /> { MECHANICS, <br /> any offer contractor <br /> InvoMO <br /> 10. OTHER <br /> INFORMATION <br /> OR REMARKS 1w. <br /> Meadows Mbrmmbn on any Mme aoesa ON",a others b M adrMaE when Wing Is In progress or oo iaiwww Maaon a obsennus pr«ant"not sees.«c. <br /> s <br /> - Tests were made on the above tank systems In accordance with test procedures re"bad for. <br /> 11. TEST RESULTS - -,.as detailed on attached test charts with results as follows <br /> - Tani lesntlllptlon <br /> ei. Tight U*,Wa Indicated J ... Date Taabd <br /> 12. SENSOR 13.This is to certify that these tank systems were tested on the date(s)shown.Those Indicated as"Tight"meet the criteria established by <br /> . CERTIFICATION - the National Fire Protection Association Pamphlet 329::. <br /> Teobgei« _ '.it is the respensMilityof Meowner andforoperetor Or this system b immediately advise state aMbcal authorities of any <br /> Implied heard and the possibility of any r9poinable,pollution to the environment u a result of Oro Indicated failure of this <br /> C Date system.Heath consulte17r <br /> SACRAMENTO EQUIPMENT MAINTENANCE COMPANY,INC.does not <br /> assume my responsibility ss Of praduc)to the emlronmant. <br /> aerlm TMrmY DN1lapadpe a Tenk Owner/Operator ( DateJ_(J ! <br /> Owtlacatlanl 101 <br />