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Data Art for Tank System TightOss Test <br /> ;P <br /> PLEASE PRINT PETRO-{F9EGK INC. <br /> 1. OWNER Property ❑ TOWN & COUNTRY CONTRACTORS 117 OTTO CIRCLE, SACRAMENTO, CA 95682 <br /> ❑ Name Address Representative Telephone <br /> Tank(s) JOHN 91 2-1860 <br /> Name Address Representative Telephone <br /> 2. OPERATOR CITY OF LODI 1331 SOUTH HAM, LODI, CA Telephone <br /> Name Address <br /> 3. REASON FOR REGULATION GOVERNING UNDERGROUND STORAGE OF HAZARDOUS SUBSTANCES. <br /> TEST SUBCHAPTER 16 OF CHAPTER 3 TITLE 23 OF THE CALIFORNIA ADMINISTRATIVE CODE <br /> (Explain Fully) <br /> 4. WHO REQUESTED OWNER company or Affiliation Date <br /> TEST AND WHEN Name Title <br /> Address Telephone <br /> 5. WHO IS PAYINGOWNER Title Telephone <br /> FOR THIS TEST? Company,Agency or Individual Person Authorizing <br /> Billing Address City State Zip <br /> Attention of: Order No. Other Instructions <br /> Identify by Direction Capacity Brand/Supplier Grade Approx.Aye Steel/Fiberglass <br /> 6. TANK(S) INVOLVED N/S #1 5,000 DIESEL NEW D/W STELL <br /> /W #2 10,000 UNLEADED NEW D STEEL <br /> E/W #3 2,000 REGULAR NEW D STEEL <br /> E/W #4 2,000 WASTE OIL NEW D/W STEEL <br /> Location Cover Fills Vents Siphons Pumps <br /> 7. INSTALLATION CENTER OF EDJACKET <br /> DATA ORP. YARD GRAVEL 411 Overf low 2" TMBINE <br /> North inside driveway, Concrete.Black Top. Size,Titelill make,Drop Suction,Remote, <br /> Rear of station,etc. Earth,etc, tubes.Remote Fills Size.Manifoldod Which tanks? Make if known <br /> Is the water over the tank? <br /> 8. UNDERGROUND <br /> WATER Depth to the Water table N/A DOUBLE WATT, TANKS ❑ Yes ❑ No <br /> Tanks to be filled hr. Date Arranged by_ Name Telephone <br /> 9. FILL-UP <br /> Extra product to"top elf"and run TSTT. How and who to provide? Consider NO Lead. <br /> ARRANGEMENTS <br /> Terminal or other contact <br /> for notice or inquiryName Telephone <br /> company _ p <br /> "1 <br /> 10. CONTRACTOR, <br /> MECHANICS, MID <br /> any other contractor <br /> involved NVII� <br /> 11. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> Additional information on any items above.Officials or others to be advised when testing is in progress or completed.Visitors a observers present <br /> during test etc. <br /> Tests were made on the above tank systems in accordance with test procedures prescribed for PP_?Tro Tite <br /> 12. TEST RESULTS as detailed on attached test charts with results as follows: ' <br /> Tank Idenulicatwn Tight Leakage Indicated <br /> Date Tested <br /> GH <br /> DIESEL TIGHT NONE —.009 10-28-8 <br /> —.033 _ 10-28-88 <br /> TIGHT NONE —.026 10-28-88 <br /> NONE —.002 1 10-28-88 <br /> This is to certify that these tank systems were tested on the dates)shown.Those indicated as"Tight"meet the CNttaria estabNsttad by <br /> 13. CERTIFICATION the National Fire Protection Asocistion Pamphlet 329. <br /> OCTOBER 28, 1988 BILL CAMPBELL PETRO—CHECK, INC. <br /> 1819; 1`9,4, 1972 414£ 116 271 OPPORTUN_ c�rn'jtirac'oro§fp�hp�p�. C By SAS�j ^ NTO CA 95 38 <br /> Sony No of Thermal Technicians UAddd�rre�sss, <br /> Senna <br />