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2004 Piccoli #9 <br /> Stockton, Ca 95205 (209)931-1626FIE- 71 + r 7) <br /> TEST RE-PORT , <br /> . OWtJER OF SITE�� <br /> ADDRESS I1_ S f CITY1 /tdC 1, STATE_L_ZIP2 <br /> (� <br /> OWNER OF TANK <br /> '`'1.r`"'`' <br /> ADDRESS <br /> . CITY STATE ZIP <br /> OPERATOR AT LOCATION ) ) 1 • <br /> ADDRESS `� J,.J1 / , , „ .� ; CITY <br /> NAME OF COUNTY . - STATEZrZIPG <br /> TANK 0.. ()�1 t ON PLOT PLAN. AGE OF TANK_ + `% <br /> DESCRIPTION Or TANK: / y /� '• <br /> CAPACITY O,) �) 09DIAMETER `� , METAL _ FIBERGLASS <br /> TYPE OF SYSTEM: SUCTION/_: SUBMERSIBLE OTHER <br /> VAPOR RECOVERY SYSTEM? \ ; TYPE <br /> PRODUCT BEING TESTED <br /> MEASURED GRAVIIT_ • <br /> COEFFICIENT " � • r TEh1�ERATURE OF PRODUCT �/() • <br /> STORAGE SySTE►q: , AIR "3 .. . <br /> FILLED = DATE 1 - I '3 �'L_`'L_"._► TAME <br /> TESTED - DATE START • <br /> LENGTH OF TEST -� 9 S U , FINISH . <br /> MEASURED WATER IN TANK <br /> •vb- FtEIGHT OF LIQUID LEVEL1 <br /> DEPTH OF GROUND WATER PSI AT TANK BOTTOM <br /> i RESULTS OF TEST: <br /> CERTIFIED TIGHT? - YES ' . ' <br /> LEAK RATE PER HOUR: + �"' N----' IF NO EXPLAIN IN REMARKS. - <br /> or -�_��J Yg . <br /> REMARKS BY OPERATOR <br /> NAME OF OPERATORR�i �G - �• <br /> i <br /> SIGNATURE OF OPERAT <br /> DATE - - <br /> 7,1 <br /> • !•,iii <br />