Laserfiche WebLink
Ilvv ?:- ICON1 RUC-f1r�N <br /> 1'-0- UUX 30407 <br /> SIOCKI(PH CA 95213 <br /> (2.1)9) 931- 1020 • LICENSED <br /> fAX (21)9) 465-3006 INSURED <br /> OWNER of s1TE: . .j3ft — LICENSE #9 _ <br /> �'�^� ft - l X_�cC-Lur) 1 _ 21248 <br /> AUDRESS:� ".t � � E=�IIJI/' ;ICITY: _ ) ~ LEOIJARo F. CRISP <br /> JJ <br /> OIVNF,R OF T'ANKS:__ _ �� ZIP:_. � <br /> -- -. ra <br /> ,QGt , (' <br /> _ -- - - - CITY: <br /> OPERATOR AT r,OCATION:.__. ZJP: - <br /> Ar)DRPSS: _ _ _ <br /> COUNTY:Pav G���eUL1/_ 7'A NK'+: <br /> MFTAIJyJ FIBF,RGI,ASS( ) SINGLE WAI.I.ED( A DOUBLE WALLED( ) <br /> DIF,SFI,(d) UNLEADED ( ) PRFMJ(Ih1 UNL. ( ) _ <br /> SUCTIONO SUBMERSIBLE( ) OVERSPILL CONTAINER`-Y13S( ) NO(><)) <br /> SHEAR VAI.VF,"YES( ) NO(y) IN I,1NF. LF,AK DF'I'FCTOR"YES( ) NO(yJ <br /> VAPOR RECOVERY SYSTEM"YF,S( ) NO(-,4 1F YES, PIIASf; I( ) PHASE 11( ) <br /> TANK FILL BATF,: '�L'�N. TIME: 17Q0 <br /> TAN TEST DATb-_8__ a�Y- START - _-. T;ND:_P I.Qv__ <br /> LENGTH OF TESTA ..__ C <br /> TANK BOTTOM TO GRADE......L TIiST LEVEL 'I'0 TANK BOTTOM.. <br /> TANK TOP TO GRADE............ GROUND WATER ABOVE TANK..... ' <br /> DIAMF,TFR....................---.... PS1.................... <br /> WAT IN 3.L._ <br /> LF, ABOVE. GROUND.-LU-_ NET TEST PRFSSURF....................... <br /> NATER IN TANK.........._........__ �- API SPECIFIC GRAVITY.. S_ <br /> DFPTH FOR TAKING SAMPLE..._�6.Jr_" T -MPF.RATiIRF................................. �- <br /> TEMPERATURE PROBE DEPTH.... API SPECIFIC GRAVITYcm 60' F......_3�. <br /> COEFFICIENT OF F.XP...................o�o h�5zr� <br /> LEAK RATE PF:R/IIR:, ._ _ / DkA-1 l <br /> CER'T'IFIED TIGHT: YFStl/� NO( ) <br /> PRODUCT LINE TEST: SUCTION(-") PRESSURE( ) <br /> LEAK RATE PER/HR: <br /> CERTIFIED TIGHT: YES( () NO( ) <br /> UATE:vl�- _�4-- a <br /> SIGNATURE, OF TES'1'F. <br /> COMMENTS:------ --__--- <br />