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Data Chart r Tank System Tightness est <br /> LCAst PRINT clIAMPIOWS T12L'CISIQN TANK <br />'! 1. OWNER Prow , ❑ •• n.n....nu,.•, lb..no. <br /> Am.. <br /> r' Tan\hl ❑ wan... n.r....mn... +•' <br /> T m rn°" <br /> J <br /> 2. OPERATOR <br /> sass.,• <br /> 3. REASON FOR N GOVERNING UNDERGROUND S-rORAGIi OF HAZARDOUS SUBSTANCES <br /> TEST SUBCIIAPTE'R 16 OF CIIAP'rER 3 OF TITLE 23 OF TILE CALIFORNIA ADMINISTF:ATIVE CODE <br /> (6oldn runrl <br /> OWNER <br /> 2, WHO REOUESTEO c°^°•"•°'""""""" <br /> TEST AND WHEN " <br /> wee... <br /> S. WHO IS PAYING <br /> FOR THIS TESTI [e wnr.we•nt•ai lne..w •' ••'•O """"0 __ <br /> s,x...e wea.•n <br /> assn"° Otho..arvu.m. <br /> Au•nnen el: ' <br /> none/5unnho r•e• wpwo..Aq. GSl.d/ib.•pbM <br /> le.nnh tar D".11-on fwprt•,r d��= <br /> " <br /> TANK(S) INVOLVED _ 1� � .FAQ dIt <br /> �S F V Yl V1L. I t <br /> v.nl. bnnen.. rtrn.o. <br /> Loc.".. Geon Fill, `�• �..`� ✓' <br /> INSTALLATION T-- \SaC�16T <br /> DATA �yCc � u/i I ra// II6S � L7zPjnrc�syt <br /> Csw . n�. o'er S nwn,a•sw. <br /> Mann mua•enowq• onr Rbr. ler. Sas .— ,r Ln, S.r•.Mm,rele•e Wn•tn unU, ur.r ruswn <br /> R.0 al nanen.n. lam..Ic lues <br /> It IM wtbr e.•r IMP •n\7 <br /> B. UNDERGROUND .. Y.. ❑ No <br /> WATER Doth Ie In.WSW ISUI. <br /> Tani..o he huidE M � D.11 Nonpre hr _._--- n•—. 1r.. o^• <br /> 9. FILL-UP ..nn m mn.•n•' rnn.m.r Pro k..e <br /> ARRANGEMENTS I•n•nroeuu.o"Inn oft'and I.-T5TT ltow •ne —_ <br /> 4Wfrinn,acl e oer romountnl•c Er,rCTe�n-•r <br /> l �ne5 ww..r <br /> 1D. a i l!V_'11'�1 Sasso�^e. <br /> ,. <br /> CONTRACTOR, <br /> ------- <br /> 'MECHANICS. -'-- -. - <br /> •nr elan cenvae• <br /> M.plr.d — <br /> 11. OTHER - ' <br /> INFORMATION <br /> --- <br /> OR REMARKS •._.. .----..--'-'--'- <br /> ACen.nnal.nmrmn 1 un a..:..�v... .. .• 0...nn.t••n. .�,m b• .n..,.n+cash leanp n . .rnyrt+n• tmm�la•e vnnnt o.oe.nm.—Ponca= <br /> e•p.np tea+ It <br /> last.were mane on the above tank .yslems 1n attordan,with Irsl Ptnc•dures prertnNed for F1%3'Ito-PITC <br /> 12. TEST RESULTS — �+ detadea on maenra tete that. wdh rrktrn, as sono.•. <br /> 1 M( t. "nrt I D... l.,••n <br /> ! _ -G <br /> 1 <br /> This•1.to eerllty that there tank.ymemr were Ie.led on the dalN•l Shown.Those Indicated a"Tight"mnel the ersteti,artabilahad by <br /> 13. CERTIFICATION the National Fire Projection A.o[1.hon Pamphlet )77 <br /> Ci1.4P11'I.ON'S I'RECIS].ON TANK TESTING <br /> _—u.,. --- _ �"_^ �+ i I•(T Ia,;., I •1ClS'.1 :.}fin alF�l:l'I'O"' CA�n.�.��i 3-3059 <br /> — <br /> - - .,ACB <br /> r <br /> nar,-,- <br /> Swu •1•sass^.. L.........., <br />