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74o"bP lank Te 'ng ColslrucIifn Company <br /> r Phone (209) 934.1828 <br /> Poll OM CO Box 30481 <br /> 9focldO%Calllornla 95213 cleansed <br /> LICENSE #92-1248 Insured <br /> OWNER OF SITE: S /r RrI,OR'I,* + LEONARD E.C.. 7' CRISP <br /> ADDRESS: Ig9oO I I V�/V GG► �� <br /> OWNER OF TANKS: CITY -- Ar <br /> ADDRESS: _--_-.-- <br /> - ------------- <br /> OPERATOR <br /> AT LOCATION: <br /> - <br /> ADbRESSs� —`y----`�------ --- - -- ----- <br /> COUNTY t 5m. <br /> - 71 11 <br /> 'YANK il :— y,/ Ar;r : <br /> METAL(X) FIBERGLAS$( ) — - - -- —� � <br /> DIESEL(() SIhIr,l,I; Nnl,r,r:n(X) DON01,r; IJAt.LIib(�— <br /> UtJLEAbED( ) PREMLNII I1111, ) <br /> WASTE OIL( ) KEROSENE( ) AVIATInN r;AP,(rinDliN( <br /> ) <br /> SUCTION( - ( ) <br /> () SUUMERSI"Lr( ) OPT FUEL( ) WATER( ) <br /> SHEAR' VALVE--YES( ) NO oVFitt' It,I, 0011'1'Ai17rR--Yr;( ) ( <br /> VAPOR RECOVERY SYS'PE (X) IN- r,rtll; Fl(1 <br /> n!; NIS'I'I:C'9'Ort1JO(X) <br /> No(X) F <br /> TANK FILL DATE: Yr:; , !'IIASr t ( ) PIIASr, 7. ( ) <br /> TANK TEST DATE: � I .IHE ;—�o <br /> TANK BOTTOM To G 16 2 STA RS';��j� <br /> RADE. . . . 13 'U IiNN: LU - r,r;NG'I'U or TE,S'I':�_ <br /> TANK TOP To GRADE. . . . . . . -- - r I' '' I' I,I:VI:I, 'I'O <br /> 130Vr, 11O'I"I'ON-.-- <br /> T <br /> DIAMETER. . r . , -�_. r;1tONrN> arn'rrR Anovr, •rnNu . . -� <br /> TEST LEVEL ABOVE GROUND. - . . . . . . . . . • . . . <br /> WATER IN TANK . . . — I' NET rlar 1'Rr,r _ r0 <br /> � .nRr. . . . . . . . 4_66 <br /> DEPTH FOR TAKING SAMPLE.� S A1, r ^r'I?( r:ItAV . . . . . . . . <br /> TEMPERATURE PROBE DEP'1'II. -- <br /> AI11 ,;1'1;:(* GI?AV 9 501 1; C? <br /> CERTIFIED TIGIIT--YES('?ONO( ) r'o1:r.l r] f lil•PI' Or EXI . . . . . , — <br /> r LI:AI( RATE I'rR/tIR: + <br /> PRODUOT LINE TEST--PASS( ) FALL( ) ----/- <br /> CERTIFIED TIGIIT .=YES( ) NO( ) S,jC'PtoN( ) PItrSSUft[:( ) <br /> 1,IiA11 RA'I'I4 tett/illi : 6 <br /> DATE: _ 92 — <br /> SIGNATURr; or 'rr:;•t•r , <br /> COMMENTS : <br /> i <br /> ----------------------------- <br /> -- ---__ <br /> r <br />