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Data CA for Tank System Tightnts Test <br /> /� / petro TitP <br /> PLEASE PRINT ht / %�./ TANK TESTER •�� <br /> 1. OWNER Property <br /> �" Nam• p <br /> Tank(sl y',;l�gsp�e.fyet�.a �� r.Iso^p^e <br /> /` Name Aoareu /ReoGGr...>//en'Ylfau.e ru.onan• <br /> 2. OPERATOR <br /> Name Address rae°non• <br /> 3. REASON FOR 4(Z f1' <br /> TEST <br /> (Explain Fully) <br /> 4. WHO REQUESTED <br /> TEST AND WHEN Name Tin• comoanr or ADn;apon <br /> on. <br /> Amus rtl•onone <br /> 5. WHO IS PAYING d /� <br /> FOR THIS TESTI Comwnr.Asencr pr lnelrleval Person Authorizing me rsleonone <br /> aillln0 AddlaU CITY Stale ZIp <br /> Attention°I: 014.1 No. D�nel lntlrYGli°nr <br /> Identify by o°acUon Capacity grand/Supplier Grade Aopmx.Age Steal/Fiberglass <br /> 6. TANK(S) INVOLVED <br /> S 7—to <br /> A„ ,�7 r1N'm/rrrri 9Ye W r <br /> Location Cover fills Vents Sonoma Pumps <br /> 7. INSTALLATION <br /> DATA Go»�l2/L e' ,2 /,At d <br /> yAGICET <br /> Nolen Inilde edvwar. Concrete.slack Ta°. Size.Tie ill make,Drop Suc°on.A,Ino A. <br /> Rxl of station,el[. Eum,e10. NOBS.Remote Fills Site.Men;lolp•E W nith tante I Mak•tl known <br /> 6. UNDERGROUND Is Ine.vno perp me tank r <br /> WATER Depen w the Water table <br /> /��� yes No <br /> 9. FILL-UP Tar t to be fille¢,�_[�hr. Z� Da:e Arranged by e/ <br /> ARRANGEMENTS ,,,°^°^• <br /> Enra product to"top off”And run TSTT. How and who to provide 7 Consider NO Lead. <br /> Terminal or other contact els x..© <br /> forininal m �2 <br /> Inquiry TTYh tl- <br /> Comoanr Name hraonone <br /> 10. CONTRACTOR, <br /> MECHANICS, — <br /> any other contractor <br /> involved <br /> 11. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> during test <br /> etc. <br /> l I... tipn on any <br /> dodltitems above.Officials or others to be advised when testing is In progress pr completed.VP I ore or observers present <br /> Tests Were made on IM above tank systems in accordance with test procedures prescribed for }TO Il(• <br /> 12. TEST RESULTS es classified on attached tut charts with results as follows: TOMT <br /> Tank Identification Tight Leakage In ica ad <br /> Date Tested <br /> y' _ read <br /> s OD _ <br /> 2 <br /> 13. CERTIFICATION This Is to(ardly,that thou lank systems were tested on the dates)shown.Thou Indicated as"Tight"most the criteria established by <br /> the National Fire Protection Association Pamphlet 329. <br /> Lawrence Tank Testing <br /> foo -�� � P.o. BOX 407 <br /> N. sn Ivta <br /> genal Ne.of Tnermal DownievilleCalifornia 959 <br /> Sen`" ��^ °�•^• , 95936 (916) 289-3109 <br />