Laserfiche WebLink
CRISP TANK 'A'�� <br /> 2004 t iCCUlt �� hi � -w <br /> v' <br /> • � � �I � <br /> Stockton, Ca 95205 (209)931-1828 NOY 2 9 f9��g <br /> TEST REPORT <br /> ENVIRONMENTAL HEALTI.1 <br /> PERMIT/SERVICES <br /> OWNER OF SITE <br /> ADDRESS i 0 4 CITY to c STATE C..=1. ZIp7r <br /> OWNER OF TANKS <br /> ADDRESS CITY STATE ZIP <br /> OPERATOR AT LOCATION r ll }j k/ j) r j • <br /> ADDRESS 1 '� S.Z 111 / F ' CITY STATEZIPL, <br /> NAME OF COUNTY 1f,j q ; f, <br /> TANK # r2 e _ OtJ PLOT PLAN. AGE OF TANK <br /> DESCRIPTION OF TANK: <br /> CAPACITY_ZAja�,DIAMETER 1� —, METAL_�C FIBERGLASS <br /> TYPE OF SYSTEM: SUCTION_: SUBMERSIBLE OTHER <br /> VAPOR RECOVERY SYSTEM? ; TYPE <br /> PRODUCT BEING TESTED / (>% r ��_ a MEASURED GRAVITY' <br /> API SPECIEIC GRAVITY 0 60°F E4 . P.h 06UCT . TEMP.`? 0 COE ado , J 79 <br /> P <br /> STORAGE ffEM: <br /> FILLED DATE �,�.�, �;"! , TIME <br /> TESTED - DATE �' �� START . <br /> s O _I D , FINISH <br /> LENGTH OF TEST :.j <br /> MEASURED WATER IN TANK_ <br /> . _ HEIGHT OF LIQUID LEVEL__ <br /> DEPTH OF GROUND WATER— , PSI AT C. <br /> _ �� TANK BOTTOM <br /> RESULTS OF TEST: <br /> CERTIFIED TIGHT? - YES �✓ ; NO IF NO EXPLAIN IN REMARKS. <br /> LEAK RATE PER HOUR: + ; or <br /> REMARKS BY OPERATOR <br /> r • <br /> NAME OF OPERATOR <br /> �. 1: <br /> SIGNATURE OF OPERATOR � ' ' <br />