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IIII ,III Champion • <br /> Precision Tank Testing Sste Tightness Test <br /> Licensee No. 73848 Data Chart for Tanky <br /> STORE # 21756 <br /> PLEASE PRINT <br /> 1. OWNER Prop"❑ padReyesenuhv< Telephone <br /> re" <br /> Name <br /> TanFlg❑ Zip Repmsenbeve Televnone <br /> N.T. Address <br /> MANTECA Wall... <br /> 2. OPERATOR Name pddreae Z'° <br /> CAI IE (209) 221-4110 3. REASON FOR REGULATIONS GOVERNING UNDERGROUND STG�E_t1A7ARD011_S�UBST LFS SUB�I9NCES <br /> ORA <br /> TEST SUBCHAPTER 16 OF CHAPTER 3 TITLE 23 OF CALIFORNIA ADMINISTRATIVE CODE. <br /> (Explain Fully) <br /> 4. WHO REQUESTED yle company or Aailiation Dat. <br /> TEST AND WHEN Name <br /> Address <br /> Z° Telephone <br /> Steel/Fiber chass <br /> Identity by Direction Capacity Brand/SupplierGrade Apprm.Age g a <br /> 5. TANK INVOLVED G <br /> t✓csf�a� /6 6 G -- <br /> i additional lines Cr �a- ae <br /> for menifulded tanks <br /> Location 1/ O Co•er Fines �C (.eLsf_-(`ma7s / vents / SiptonJ , <br /> IA'fAI c <br /> 6. INSTALLATION <br /> DATA <br /> .5(Dr�• 1/l V �/ suction.Ram". <br /> North inside driveway. Concrete.Black Top. Sire.Tltelill make.Drop <br /> Rear of station.etc. is etc. tubes.Remota Fills Sire.Manilolde0 Which ranks' Make it known <br /> ��� � � v is the water wa[r�the tank' <br /> 7. UNDERGROUND �� a/Oy�_L�37 /r� ❑yes C'No <br /> WATER Depth to the water table from grade <br /> Tanks to be filled hr. Data Arranged by Name telephone <br /> 8. FILL-UP <br /> ARRANGEMENTS Exireproduct to'Top orr and run tank teeter. How and who to provide' Consider NO Lead. <br /> TESTING COMPANY <br /> Terminal or other contact Telephone <br /> for notice or inquiry Company Name <br /> 9. CONTRACTOR, SELF LEVELING STANDPIPE AND DTS. MOO <br /> MECHANICS, <br /> any other contractor <br /> involved <br /> 10. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> Additional mtormation an any imma above Onicials or,others In be advised when testing Is In progress or completed.Vrs�mrs or observers Present <br /> during les. c. <br /> 11. TEST METHOD © PETRO TITE J7 ❑ PETRO COMP ❑ QUICK CHECK 2000 <br /> Tests was made on the above tank systems In sccordence with test Procedures prescribed for <br /> Ila. TEST RESULTS as detailed on attached lest charts with results as follows: <br /> Net Volume Charge Par Hour Date Tested <br /> Tank Itlenuncahon Tight 2 <br /> es fN :eG le S /Z —Z T— Z <br /> Crn f r ` — Z —2 7-9 Z <br /> 12. SENSOR 13. ACTOR CERTIFICATION CHAMPIONS PRECISION TANK TESTING <br /> P P.O. BOX 13059 <br /> CERTIFICATION <br /> P �IiIiIN ", T°<hn ' SACRAMENTO. CALIF. 95813 <br /> Date Q 1. Taking Convector or Company. BY 59nature <br /> Sart.)No OfM <br /> ThWaked Certification <br /> (916)927-1557 CALIFd's=.800-660-9443 <br /> IF. <br /> NEV. 1-800-949-9443 <br /> pNF.01T <br /> Certification s <br />