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• • . 1 CJ I IfVli Lc CON I Ruc I-ION CO. <br /> P.O. BOX 30-107 • <br /> 511.1CKJON, CA 95213 1_ICEr1SE8 <br /> (7_09) 931- 1820 I11SURED <br /> fAX (209) 465-300G <br /> "'TEST REPORT* * ** * <br /> OWNER or SITE: LICENSE „=5< <br /> JY _..I_Y �AC� _1.V1��\ LEONAPD E. CRI,':P <br /> - - <br /> ADDRF,SS:l KW-1 _._ v_ r -- <br /> OWNER OF 'TANKS:—__---- <br /> -- <br /> ADDRESS _-.-_-. <br /> OPriRATOR AT LOCATION:---- --_ Y�L <br /> e 71P _.. <br /> r.OUN'rY:,� a-4.,, rnraK„:_`` _.._ <br /> ,�. ::.- <br /> MF'('A1,( ) FIIirRG1,ASS( ) SINGI,Ii WALLIiUnrr <br /> ( ) UOIt[)I,F WALLGnr,LOlvs:. <br /> ED( ) <br /> DIFSEL(Y( UNLEADED ( ) PRFMEUM IJNI,. ( ) <br /> .SIJ(-.TION( ) SUBMF,RSIBI,F( ) OVrRSPII,I, CON'I'A1NI'sR”"YIiS( ) NO )) <br /> SHEAR VALVE"YES( ) N0( ) IN-LINE, LEAK DETEICTOR"YES( ) NO( ) <br /> VAPOR RECOVERY SYSTEM"YfS( ) NO( ) 1F YRS, PIIASr I( ) PIIASr ll( ) <br /> TANK FILL UATF,:d73D0�/L Ti ME: /Wc) .. <br /> TANK TEST DATF.:a�%9`f-- START--aZd6- ii NU:O_Qa..G. -- <br /> LIiNGTII OP TE <br /> TANK <br /> TANK BOTTOM TO GRADE..... LEVF1. '1'0 'TANK BOT'rOhT... <br /> TANK TOP TO GRADE...........-_ GROl1NU WATER ABOVE TANK..... <br /> DIAMETER..::......................... `j Y"- PS1.................... ..........:...................._Q � _ <br /> TEST LEVEL ABOVE GROUND.-/U._--_" NET TEST PRrS'.SIJRF.......................y, j ( <br /> WATER IN TANK...................._,� API SPECIFIC GRAVITY.................. <br /> DEPTI! FOR TAKING SAMPLR... D_.- TEMPERATURE- <br /> " <br /> EMPERATURE......... ..... ......._°7.(_ __... <br /> TEMPERATURE. PROBE DEPTH.... -5.__" API S P F C I r I C GRAV1TY.....c.'+ 6.0..... <br /> ' <br /> COEFFICIENT Or EXP....................400095S77 <br /> LEAK RATE PER/IIR:,._-. <br /> ( IiRTIF(liI) TIGHT: YES( ) NO( ) <br /> PRODUCT LINE TEST: SUCTION( ) PRESSURE( ) <br /> LEAK RA'Z'E PF,R/IIR: <br /> ( CERTIFIED TIGHT: YES( ) NO( ) <br /> SIGNATURE OF TEiS'rr <br /> COMMENT'S: ..__ ---- -- --- - . <br />