Laserfiche WebLink
CRISP TANK <br /> 2004 PIccoli ,-#--9 ENViRONMENTAI HEALTH <br /> • PFRr.n . . - <br /> Stockton, Ca 95205 (209)931.1828 <br /> TEST RCPORT <br /> OWNER OF SITES �d u <br /> ADDRESS CITY o c ,� STATECZIP` <br /> OWNER OF TANKS a !» e - ; - // Uy <br /> ADDRESS CITY <br /> STATE ZIP <br /> OPERATADDRESS-L2 AT LOCATION Jj p r <br /> 1 c/ 3 2 ll/ /-- c'. P /f7 a / CITY�fDC�rf�� 1� STATE�_ZIP` 5�?0 <br /> NAME OF COUNTY ' y <br /> TANK i!! ) e _ ON PLOT PLAN. AGE OF TANK <br /> DESCRIPTION OF TANK: <br /> CAPACITY Gar) ,DIAMETER / , METAL FIBERGLASS <br /> TYPE OF SYSTEM: SUCTION_: SUBMERSIBLE OTHER <br /> VAPOR RECOVERY SYSTEM? ; TYPE • <br /> PRODUCT BEING TESTED • <br /> MEASURED GRAVITY��__• <br /> API SPECIFIC GRAVITY R 60°F PRODUCT <br /> ,_TEMP.`70 COE Did k <br /> STORAGE FILLEU:` DATE �( d� ��rJ ' TIME <br /> I Ivo <br /> TESTED - DATE STARiQ_B_IQ _, FINISH <br /> LENGTH OF TEST <br /> MEASURED WATER IN TANK , <br /> - HEIGHT OF LIQUID LEVEL <br /> DEPTH OF GROUND WATER-- PSI AT TANK BOTTOM <br /> RESULTS OF TEST: <br /> CERTIFIED TIGHT? - YES__y ; NO IF NO EXPLAIN IN REMARKS. ' <br /> LEAK RATE PER HOUR: + ; or _1 0 !r3 . <br /> REMARKS BY OPERATOR <br /> NAME OF OPERATOR <br /> SIGNATURE OF OPERATOR " <br />