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Champion P.O. Box 13059 <br /> Sacramento, CA 95813-3059 <br /> Precision Tank Testing CA 800-660-9443 <br /> License No. 73848 NEV 800-949-9443 <br /> (916) 927-1557 <br /> Fax: (916) 927-7345 <br /> HORNER EZY-CHECK CERTIFICATION <br /> Property <br /> Owner : 57-oc(<-r6 LttjScFfooe- <br /> �isT <br /> Address : lo/3 Z /L) EL /P,A,,4 7-a c/GtLN cA, <br /> Tank Address : 5,4 <br /> *Notice to owner(s)* A copy of this test result has been filed with the proper regulatory <br /> agency. It is the responsibility of the owner(s) to contact the local Env. ,Health Dept. in <br /> his or her area of any tank failure within (24) hours of testing. <br /> Tank Product Capacity Apx . Age Steel Fiberglass Supplier <br /> pec-SC—L <br /> G(,t,cE � CEN/EAc7�(� O <br /> Tank( s ) were filled on : Distributor : e: 4, 13,e <br /> Date Time <br /> Extra product to top off :_No[ Yes[ ] Gallons <br /> Comments : <br /> TEST RESULTS INCLUDE <br /> Tank( s ) c--- Product Line( s ) Vapor Recovery System Vent Line ( s ) / <br /> Tank Tight Tight Leak indicated Leak indicated Date of <br /> ID# Tank( s ) Line ( 2 ) per hr . ( tank) per hr. ( line ) testing <br /> .-3 Yes [ �"o[ ]Yes[ No[ ] t,00sS �f`-�� <br /> k/c 51A Yes [kTNo[ ]Yes[ ]No [ ] <br /> Yes [ ]No[ ]Yes [ ]No[ ] <br /> Yes [ ]No[ ]Yes[ ]No [ ] <br /> Yes [ ]No[ ]Yes [ ]No[ ] <br /> Yes [ ]No( ]Yes [ ]No [ ] <br /> n � /b 1 Date : <br /> -may-9� <br /> Technician : <br /> jG-1eZ -- / � License » : <br />