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Crisp Tank Tebiing & C:oristrdMon e )an <br /> Y <br /> C <br /> Phone (209) 931-1828 Licensed <br /> Post Office Box 30487 .JUN 15 S:r 2 Insured <br /> Stockton, California 95213 ENVIRONMENTAL HEALTH LICENSE �92-1248 <br /> "pmt 'CN LEONARD E. CRISP <br /> OWNER OF SITE: <br /> ADDRESS:/f' I f1/� /�1l(1� -�/,�G�ITY:�p /ii ;, r` L. �G ', CLzIP ')9G� <br /> OWNER OF TANKS: <br /> ADDRESS: CITY: ZIP : <br /> OPERATOR AT LOCATION: (%��'l <br /> ADDRESS: ITY: <br /> COUNTTANK #:_�AG E: (;7 n_z" GALLONS:. <br /> METAL() FIBERGLASS( ) SINGLE WALLED( ) DOUBLE WALLED(p <br /> DIESEL^) UNLEADED( ) PREMIUM UNLEADED( ) REGULAR LEADED( ) <br /> WASTE OIL( ) KEROSENE( ) AVIATION GAS( ) JET FUEL( ) WATER( ) <br /> SUCTION( ) SUBMERSIBLE( OVERSPILL CONTAINER--YESO() NO( ) <br /> SHEAR VALVE--YES(,)() NO( ) IN-LINE LEAK DETECTOR--YES(1() NO( ) <br /> VAPOR RECOVERY SYSTEM--YES(/\l NO( ) *IF YES , PHASE 1 (.)) PHASE 2()() <br /> TANK FILL DATE:_J-3142 TIME: 14W <br /> TANK TEST DATE: START: U END: 00 LENGTH OF TEST: G <br /> TANK BOTTOM TO GRADE. . . . / ' TEST LEVEL TO TANK BOTTOM <br /> TANK TOP TO GRADE. . . . . . . 1 GROUND WATER ABOVE TANK . . <br /> DIAMETER. . . . . . . . . . . . . . . . PSI. . . . . . . . . . . . . . . . . . . . . . , L�.3 <br /> TEST LEVEL ABOVE GROUND . � <br /> 21 NET TEST PRESSURE. . . . . . . . 4.6,f <br /> WATER IN TANK . . . . . . . . . . �' � APT SPEC GRAV . . . . . . . . . . . 3.3.5 <br /> DEPTH FOR TAKING SAMPLE. �'��) 'TEMP . . . . . . . . . . . . . . . . . . . . .. 67 <br /> TEMPERATURE PROBE DEPTH. 30 1' APT SPEC GP.AV @ 60 ' r . . . . <br /> COEFICIENT OF EXP. . . . . . . .,( ,�7 <br /> CERTIFIED TIGHT--YES(x) NO( ) LEAK RATE PER/HR: + <br /> PRODUCT LINE TEST--PASS( ) FAIL( ) SUCTION( ) PRESSURE( ) <br /> CERTIFIED TIGHT--YES( ) NO( ) LEAK RATE PER/HR:+ /- <br /> DATE: �2— SIGNATURE OF TESTE :� <br /> l - <br /> COMMENTS : <br /> REV 3/97 <br /> f <br />