Laserfiche WebLink
pp�ro Tits <br /> E`/K <br /> PLEASE PRINT WESTER <br /> 1. OWNER rropeny ❑ 7ircIp K Corporation Pat Wright Re�(.9.n16 ) 334-2445 <br /> Tank(s) ❑ 5811 Manzanita Ave . Carmichael , Ca 956U75 "nr916 ) 334-24457eM <br /> N.m. Ada, . <br /> II.p.WnYW. Ter.pnon. <br /> 2. OPERATOR Store 11 1205 16470 Cambridge , Lathrop , CA <br /> Nem$ Mo. T.Iephon. <br /> 3. REASON FOR Re ulations governing underground storage of hazardous <br /> TEST substance , subchapter 16 of chapter 3 of title 23 of the <br /> (Explain Fully) <br /> California mini r ' on Code . <br /> 4. WHO REQUESTED Pat Wright Supervisor Circle K Corp . 5/29/86 <br /> TEST AND WHEN "'n" Ti5811 Man?.anira Ave . - c [pTq rag AnUlao. m" <br /> armirhnel CA <br /> Ade.q. TY.phora <br /> 6. WHO IS PAYING Circle K Corporation Pat Wright , Supervisor (916 ) 334-2445 <br /> FOR THIS TESTI r Aa.rKr o�tna.wwi r.non Algno sera <br /> TI TrepNom <br /> X11 manzani a vee armic�iael <br /> BIIIing Addrw Gry i"t. 71P <br /> An.ntwn ol: Ord.,No. Omo irsv` wns <br /> Identity by Direction capacity Brno/Supplier Grad. Approx.Ape Stael/Frbwplam <br /> 6. TANK(S) INVOLVED 11 1 10 , 000 regular <br /> 112 10 , 000 Unleaded <br /> 113 4 ,000 Premium <br /> Location Coves Fills Vents Sipnones Pumps <br /> 7. INSTALLATION Wer tat= e-,Posh.r 1 pK 4? r2 s�o rcc end <br /> DATAt�G gMCDr�rraha^ <br /> North Wla.ddwwer. Concur.BIM Tap. ilea TmeoU m.k..Drop aystwn.Remor. <br /> Rser of ata Wn.M. Lam.M. dose.R.me"Fla. ZLM Yenlhrlded WNicN tanL 7 Wk.It known <br /> 8. UNDERGROUND Is the rater the tank 7 <br /> WATER Depth to the Waw table wtw r ❑ yes ❑ No <br /> Tanks m baled 0�hr. (e-Ile Det. Arranged by <br /> 8. FILL-UP wm. Twpnone <br /> ARRANGEMENTS Extra product to by ow-and run TSTT. Mow and who b provide 7 Consider NO Lead. <br /> Terminal or cow contact <br /> for node or inquiry <br /> COmpeny Nese iMwlarr <br /> 10. CONTRACTOR, <br /> MECHANICS, <br /> any cow conuactor <br /> invoNed <br /> 11. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> Additional info,"wn on any iterns'bow.Officials w others to be advised when matmg is in progress or cornWebd.Visitor w ob nrers present <br /> during War etc. <br /> Tomb sawn me"on its,above tank systems In accords wca with Wt pocedtlne preerlbad for �Tq_Ll� <br /> 12. TEST RESULTS BB d.bmted an albcfusd bet charts with reeDMi a logowa: <br /> Tank Identiticatwn T. hi Leakage Indicated Data Tasted <br /> YNOA TV ,4FM/4I + Q N ? Su /t, /9 L <br /> CA Sr UW c Q 5' ' . b w i — 1, <br /> t-. Oq 2 SAH E /G I YdG <br /> This 4 to arnty Bust Bwee bank systema wen meted an the dgWB)shown.Those indicated as--TW"­ROM dna prierta eteWIe1WJ by <br /> 13. CERTIFICATION mEr Netwfrt Pks hob Aaoobtwn"w"sag. <br /> o r EIMBONNEUTA1 PETROLEUM ENCN. <br /> °'" P.O. BOX 2076, ST eV"t$ 01--ft' <br /> 7G (20� 943-IOU <br /> MrW 1b a 7frrmw e.Nncrnr rag. <br /> arra <br />