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Test Rep. art <br /> 2004 Piccoli #9 Undcrground Stara©c Tank . <br /> Siacklon, CA 95205 HOR14ER SYSTEM <br /> (209)931-1828 <br /> i <br /> OWNER Of Sl IC L/�/Dc,tI a,,/r<�le _Sl eL <br /> ADDRESS 852 CAST 1 /�/ S'T, CITY ,�/ -,✓ 51ATCC�i ZIP 49 <br /> 5 <br /> OIJtJER OF TAI•JI< ;J J) -�/ ,� ' �� .S'Gla aL s ,er[T 2 r) i 7 <br /> ADDRESS .17 EAS /� /�/`,5' r CITSTATE(aZIP`/5 . Rr),-„ENTAL HEALTH <br /> OPERATOR AT LOCATIOhJ cGY] E- r oaL, FERMIT/SERVICES <br /> ADDRESS 7oo-Z 41 42z; CITY ,� �/ STATEC�ZIP 9 -2 <br /> NAME OF COUNTY 3/9-^/ 1/1,4 u►rJ <br /> TANK 11 ON PLOT PLAN. <br /> DESCRIPTIG[I OF TANK: CAPACITY_J] ,gc_,DIAMETER SSSS” AGE—_?-6- ,cY S____ <br /> METAL_; FIBERGLASS AGEOF LINES ref <br /> STORAGE SYSTEM: TYPE- SUCTION X , SUBMERSIBLE OTHER <br /> FILLED - DATE-j- -7-�-7 , TIME <br /> TESTED - DATES-8.7' , STARTS , FINISH /64.30 <br /> LENGTH OF TEST / yes <br /> VAPOR RECOVERY SYSTEM /(/a ; TYPE ' <br /> PRODUCT BEING TESTED MEASURED GRAVITY S`�, 7 - <br /> COEFFICIENT 7 TEMPERATURES: PRODUCT XSzO , AIR Jr-7c- <br /> WATER IN TANI< —c, - DEPTH OF' TANK TOP FROM GROUND LEVEL /2 " <br /> GROUND WATER t3eL-�-2e . LIQUID LEVEL IN STANDPIPE /SS" <br /> TEST RESULTS: <br /> CERTIFIED TIGHT? - YES ^; NO <br /> IF NO, EXPLAIN IN REMARKS BY OPERATOR BELOW. <br /> LEAK RATE PER HOUR: <br /> REMARKS BY OPERATOR <br /> NAME Of f1P>:R4T Or: 1 ccs.✓/{ kb <br /> SIGNATURE ' -2:a-L- <br /> V <br /> ,.L L <br /> EIATF / ` <br />