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CRISP iANX TESTlflG p ail <br /> P. o. pox 30497 <br /> srocxio:r, :A 95213 LICENSE #92-1248 <br /> 1209) 931.1823 r E 0 2 G 100 <br /> LEONARD E. CRISP <br /> CN P�ERMITHEALTH <br /> ISERNICES • <br /> 111s T lTr•,ror.'r <br /> 014N •,'Z OFS.i'T.r_. • <br /> ADUR> sS Iffl I v (-TaC-k:@12LCI.'TY _ nam , 7,IP �sa3� • <br /> OWNER OF TANK(S) _-SnjWj <br /> ADDRESS CT:'1'Y , ZIP <br /> OPERATOR AT I-OCAT.TUN� C <br /> Ci'TY �i , CALIF. 7,Ipq.T;Q,- <br /> NAME OF CUUN'I'Y_S('An aj Clu lv� <br /> TANK-if ON Pt,OT Pl.,AN. AGE OF 'TANK YRS. CAPACITYJO,"ALLONS• <br /> D] r.•.SEL PREMIUM UNLEADED , -UNi.,EADED , REGULAR , <br /> KEROSENE U'I'llt h <br /> iiE'I'AL F113E[tG[,AS5LIA VAPOR RECOVERY • SYS'TEMs YES�KNO <br /> TYPE OF SYS'1'm: SUCTION-, SUTIME siBLE , OTHER • <br /> MEASURED ACI SP1;Ci.FIC GRAVI'T'Y, --. t'RODUC'T 'TEMPERATURE_ ,_qS <br /> API SPECIFIC GRAVITY C?GU' F-5g,o <br /> COErFICI.EN'r or EXPANSION_ <br /> 'T'ANItr l i,i,f?U - DATE � 2 �� . 'vitir _ <br /> TArJI; '1'ES'I'E1) - 1)ATF START �Il • ► FINISH__ �. <br /> LENGTII OF TEST <br /> 'T.'ANK lio'1"roM TO GRADETANK TUI' TO GRADE_,*?g � <br /> DIAMETER l�j„ TEST LEVEL AT30VE GRADE- j!j " . WATER IN TANK,,. <br /> DEPTH FOR 'TAKING SAMPLE . TEMP. PROBE DEPTH,_��. <br /> TEST LEVET, TO TANK BOTTOM L- ". rROUNDWATER ABOVE 'TANK <br /> PRoDUC'I' PRESSURE per 111 iIEI01111_,_01Q_PSI . 4,06q <br /> **RESUI.,TS or 'TEST** <br /> CERTIFIED '1'IGIIr: YES_XNO '. <br /> LEAK RATE PER 11OUR : + • ()��iL� �' ,i <br /> SIGNATURE Or OI'i;RA'I'OR — NAME_Lf-brNaffAs <br />