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r . <br /> Crisp Tank Testing & Construction Compan <br /> Phone (209) 931-1828 <br /> Stoc Postfon, CaliCo alfo n a895213 E � " � <br /> Licensed <br /> SEP 0 6 ''^, Insured <br /> ENVIRONMENTAL HEALTH LI'CDt;E #92-1248 <br /> �/ tgS LEONARD E. CRISP <br /> OWNER OF SITE: DATE: <br /> c ' <br /> ADDRESS: O n� <br /> OWNER OF TANK(S). CC CITY: � <br /> �. : S:ZIP: � . <br /> ADDRESS: 00 <br /> �� CITY: <br /> OPERATOR AT LOCATION: <br /> ADDRESS: U <br /> NAME OF COUNTY: n CITY: <br /> �b�Yl '�zIP:9�aa9. <br /> TANK#: AGE OF TANK: <br /> CAPACITY: �Q"( <br /> GALLONS: METAL:: <br /> SINGLE WALLED: DOUBLE WALLED: FIBERGLASS: <br /> UNLEADED: DIESEL:: PREM. UNLEADED: <br /> REGULAR L _ <br /> LEADED: <br /> KEROSENE:. WASTE OIL: <br /> VAPOR RECOVERY--YES N0: AVGAS: <br /> IF YES, PHASE I : <br /> SYSTEM TYPE__ PHASE 2 : <br /> SUCTION::SUBMERSIBLE:_ <br /> SHEAR VALVE--ygSNO INLINE LEAK DETECTOR--YES <br /> NO_ <br /> OVERSPILL CONTAINER--YES.NO <br /> TANK FILLED--DATE: -.7s tO TI<tE: <br /> TANK TESTED--DATE: `)b -- <br /> START: FINISH: I <br /> LEGNTH OF TEST: <br /> HOURS . <br /> —.MINS. <br /> TANK BOTTOM TO GRADE: 4O " . TANK TOP TO GRADE: <br /> _,/� <br /> TEST LEVEL ABOVE GRADE: 30 y DIAMETER .. <br /> DEPTH FOR TAKING SAMPLE: /3 WATER IN TANK: <br /> TEST LEVEL TO TANK BOTTOM:�„ TEMPERATURE PROBE DEPTH:: . <br /> g „ <br /> GROUND WATER ABOVE TANK . • <br /> PSI : 1031 NET TEST PRESSURE: Sal, <br /> **RESULTS OF TEST** <br /> CERTIFIED TIGHT--YES:NO <br /> LEAK RATE PER HOUR: + <br /> SIGNATURE OF TESTE . <br /> f/ �2 <br />