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�n; ar vK tS [ „v� I CJt f'14Ga <br /> 740 w. ALDER underground Storage Tank <br /> TOCKTOZ CA 952D4 HORNER SYSTEM <br /> ' OWNER OF SITE <br /> ADDRESS OF OWNER rice �6� �' 6 GITY D STATE_�ZIP94' 5F/ <br /> t. <br /> OWNER OF TANK <br /> ADDRESS OF OWNER i fSG GITY f S� _STA?E (.��ZIPG <br /> r' � �b�i <br /> NAME OF OPERATOR AT LOCATION /' ' CITY STATE (� ) ZIP T <br /> ADDRESS OF LOCATION I/ '2 ---- <br /> NAME OF COUNTY 5 c-J /J <br /> TANK ifON PLOT PLAN LOCATION. STORAGE SYSTEM FILLED: DATE ) -,-_25 %TIME f�7 <br /> _ <br /> � ') '/ TIME OF DAY: START %J"i FINISH <br /> DATE OF TEST`` <br /> LENGTH OF TEST '2 AIR TEMPERATURE <br /> DISCRIPTION OF TANK-CAPACITY DIAMETER !^ _METAL FIBERGLASS_— <br /> TYPE OF SYSTEM- SUCTION SUBMERSIBLE X OTHER— <br /> TYPE OF VAPOR RECOVERY SYSTEM �2 _----------- <br /> TYPE OF PRODUCT BEING TESTED MEASRURI-D GR,V) iTY <br /> COEFFICIENT. ' _ c <a <br /> TEMPERATURE OF PRODUCT <br /> MEASURE) `.TATER IN TANK DEPTH OF TANK TOP FROM GRJUND LEVEL �r� x <br /> DEPTH OF GROUND WATER _t ,'c HEIGHT OF LIQUID LEVEL IN TEST STAND OR STAND PIPE j r,1' <br /> AGE OF TANK AND LINES <br /> RESULTS OF TEST: CERTIFIED TIGHT: YES X NOS IF NO EXPLAIN IN REMARKS BELOW <br /> LEAK RATE PER HOUR: ♦ — 3� <br /> REMARKS BY OPERATOR ----- <br /> — NAME OF OPERATOR <br /> SIGNATURE OF OPERATC-7,L, <br /> DATE <br />