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K To*n <br /> hone (209) 931- & �onstructipn <br /> off 10 co SOX 3048 . <br /> locbon, California OmpanY <br /> 95213 <br /> AUL- U g `;-1� 11cansed <br /> ENVIRCNMENTAL HEAL <br /> PERI1nH°'ed <br /> Rr•,POR'r+• MIT/SERVICES <br /> 0"INER OF SITE: <br /> ADDRESS: L O�NP-D 2 48 <br /> I } <br /> CRISP <br /> OWNER OF TANK(S) , �` CITY <br /> c ; <br /> q <br /> AAbRESS: 1 �O I • �� �I \�� , �.. , <br /> OPERATOR AT LOCATIO <br /> ADDRESS, 7 <br /> CO )UNTYd CITY; . _ ' t� <br /> METALr 1 � IZIP ( � <br /> FIBERGLASS:_ TANK #: ` � <br /> 1 SINGLE AGF=--___YRS. <br /> DIESEL! UNLEADED WALLED: ` <br /> PREMIUff DOUBLE WALLED: 'ALS. <br /> WASTE oIL:_ uNLEAuru: <br /> KEROSENE: REGULAR <br /> SIICTIONl `-' AVIATION GAS: LEAUEU:,, <br /> SUBMERSIBLE:, JE'C FUEL:_ <br /> SMEAR VALVE--YES NO OVERSPILL CON'CAINFR__YFS WATER: <br /> VAPOR RECOVERY SYSTEM IN LINE LEAK DETECTOR__ NO , <br /> YES__NO/ � , YES_NO�, <br /> TANK FILLED-- IF YESt PRASE 1 : <br /> DATE: PIFASF, 2 : <br /> TINK TESTED--DATES '1'IFfE:_ <br /> �- ci I <br /> r\ r <br /> LINGTN OF TESTST'AR'l':� 2 <br /> : <br /> .�_IIOURS. <br />.A NK BOTTOfi TO GRADE:♦ • <br />'EST LEVEL ABOVE GRADE �O„ TANK TOP 'T'0 GRADE- ? • UiAlIF,1'ER C�Cj, <br /> WA'T'ER IN TANK• . <br />�E PT►r FOR TAKING SAMPLE: J`, <br /> "' ��' • 'I'Ef1PF.R1ITURF <br /> EST LEVEL TO TANK BOTTOM:„ PROBE UEC CII ��1 " <br /> 3t ? •/ GROUND WATER ABOVE TANK -,, , <br /> — NET TEST PRESSURE L�0 <br /> * IAPI SPEC. <br /> i13TIFIEb TIGIIT-_yF GRAV . : <br /> 6NO�• [Atli SPEC. <br /> i1K RATE PEGRAV• @ 60• F:J� C <br /> R COEF f <br /> (TOUR: + EXPt�����_`�—/� <br />,TE OF REPORT: <br /> SIGNA'T'URE. OF TF.S'I'T;R : <br /> G <br />