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•J <br />� <br />Data Chafifor Tank System Tightr -ss Test <br />petro TO <br />Jr. <br />r�kAsl rr+lr.� <br />G <br />1. OWNER hop•ny ❑ <br />City of Locii , ?21 Nest Pinc Strect:, Lodi , Dick H-iech <br />Tan►Ia) <br />'i'ty of Lodi, 1331 So."Orlam Lane, Lodi, C�"'Ca209)334-5F,37`"riOM <br />Meme MOustr RstpopentlVrr Taoepn°rw <br />` <br />Ci t y of Loci 221 H'. F'i ne St . , C'al l Box 3006, Lodi, C' 1 95241 <br />2. OPERATOR <br />Nerve A.Q race TolaonoM <br />� <br />3 REASDN FOR <br />Regulations goycrning undergrounds,Lorage. of hazardous <br />TEST <br />substances, subchapter 16 of chapter of title 23 of t h c <br />i(Eap`•'nful'y) <br />California Administration Code. <br />tk <br />4. WHOREDUESTED <br />Richard Hiech Hal ntmance SLJrl. Cit of Lodi. <br />t7l µ. Pine St , Cal 1T"Sox 3006, Lodi,`'°�°°inTab'��tt..1-1910 Dow <br />TEST AND WHEN <br />Agtliesr ToaP�on. <br />5. WHO IS PAYING <br />City of Lodi Richard hied , 19ainterlancc Super i 20 : )334-563+ <br />. <br />FOR THIS TEST? <br />CF'S • y. ''r, F". n° , c � j TwieWwrw <br />� , °? 'Qi°.""'fg`� n e 5 t . Call �'o �'r"`T'�`�`i'�, . Lodi . C A : 5 c Ori - 1 1-10 <br />got,% A6dre*. chr iNau � <br />Anenbo•- at. 0,00 Nc t7V"•V in{mucitc.ro <br />Identity by Dvocuon <br />Gpach, <br />brand/Supp!.*' <br />Gnde <br />Apprni Ap# <br />$I", Frborpl<a <br />6. TANK(S) INVOLVED <br />e " w <br />Location <br />Corm. <br />fYb <br />V.nu <br />tjq'xu»t <br />rumpa <br />7. INSTALLATION11`4 <br />c'G.,a <br />DATA <br />fs <br />` <br />Wont inside driveway, <br />Rwt: of on two. ou <br />c4ncreta Wn Top. <br />Ea rte,arts <br />iue. TMU: wake. Drop <br />wbea Re"W4 FW. <br />Brie, ttaanfloieeC <br />which bn4 T <br />Lw.tbr, Renu to <br />faa.e 11 ►rvowr <br />8. UNDERGROUND <br />/ M the wow DOW [ha ani 7 <br />WATER <br />t f <br />Depth to the waw tatbla -� L i ❑ r.a EDNo <br />Tanks to be f9W M. Date Msrpad by. <br />9. FILL -UP <br />ARRANGEMENTS <br />Extra prod6vi to "kW of and run TETT. Mow and who b prorido 7 Cain NO L"d <br />Twrnina! W oths, venue+ <br />for twtiu a inv► <br />Q01"Pe n, Iiew.e TttlprKfM <br />r �' <br />10. CONTRACTOR, <br />MECHANICS, <br />any oche. contracts <br />6111004y" <br />T esti n 1 i nes on Unl cads d ej k— <br />11.11. OTHER <br />INFORMATION <br />5 c <br />OR REMARKS <br />A6dt1rona' ntfofrn&Wn at any iume .bow OflKuie a othws to b► adva»c when tawurrp to W,propraatc a 6 -ft$ W4 V011-111 or obeolve" pattt.'" <br />dunnp toe, etc <br />TMu own clodw on tlt'n fbove uw* gy mom In w4watrwe wtn, wei proOwww p acrw ow beim _T& <br />12 TEST RESULTS <br />go &WKWIed So WAched Noi eNra Wkh MLAU w t bM$ <br />Tank mentdrutron T r.l` (.a a indreat►e Dat• taat.d <br />TTia M W Deno) ow 0~ Wn► brow -A ww* WOW W U» Mw(Si .WWI- Thou wbas"d as " Tight" MM On V%" 06u6bowE ►, <br />13 CERTIFICATION tt►ea hildnew iw womWl►en ►envoi~ IN" <br />ENVIRONMEWAt PiTFvLEUN <br />r -- M � �.► " t r M NN <br />P.0 SOA 2176 S1071'r �± <br />