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Data girt for Tank S stem Tiss <br /> TeaJ <br /> PLEASE PRINT <br /> 1. OWNER Property ❑ RMC LONESTAR PO BOX 5252, PLEASAATON, CA 94565 <br /> Tank(s) ElName Address Representative <br /> BM 57PAWRY <br /> Name Addftn representative <br /> 2. OPERATOR RNC LONESTAR SOUTH TRACY BLVD., TRACY, CA 94 <br /> Name Addftn <br /> 3. REASON FOR REGULATION GO ASG UNDERGROUND STORAGE OF HAZARDOUS IAN <br /> TEST SUBCHAPTER 16 OF CHAPTER 3 OF TITLE 23 OF THE CALIFMUA <br /> (Explain Fully) <br /> 4. WHO REQUESTED OWNER <br /> TEST AND WHEN Nan" Tifro c or A41iFam— <br /> Address <br /> 5. WHO IS PAYING MEER <br /> FOR THIS TEST? company.Agency or Individual Person Authorizing Tis, <br /> Billing Address city Sass <br /> Attention of; Order No. Omer instructions <br /> Idefflify by Direction Capacity Bfww/su w, <br /> 6. TANK(S) WOLVEO EASTIWE,ST 11000 UNLEADED <br /> Location Cover Fills Yams <br /> 7. INSTALLATION WEST OF EARTH 4" OVERFLOW in <br /> DATA SCALE E HOUSE <br /> North inside driveway. Concrsn.Black Top. Sian.Titans make,D <br /> Rear of station.aft. Earth.etc. tubes.Riationt Fills Sae,11,9610olded Whiclf anne,r <br /> 8. UNDERGROUND Is the water over the ranikt - <br /> WATER Depth to the water table ❑ yea ❑ no <br /> Tanks to be filled hr. Dab by <br /> 9. FILL-UP Nome <br /> ARRANGEMENTS Extra product to"top off"and run TSTT. Now and who to T Consider NO Lged. <br /> Terminal or other contact <br /> far notice or inquiry <br /> Company <br /> 10. CONTRACTOR. <br /> MECHANICS. <br /> any other contractor <br /> involved <br /> 11. OTHER RETEST. <br /> INFORMATION --- <br /> OR REMARKS SAN M&= CMWY. <br /> Additional information on any items above.Officials or others to be advised when testing is in progress or of <br /> during test etc. <br /> Tess were made on the atialre tank system In accordance,vAth tog procieclum prescribed for <br /> 12. TEST RESULTS % as detailed at attached too charts with results as <br /> Tank Identification Tight Leakage Indicated Oaft Tag" <br /> UNLEADED —TIGHT —.017 <br /> TMe is to that miler bink sysitsimis were,lesitod <br /> 13. CE CA 329 .. <br /> 03-24-89 CLTNTON DENMAN PETRO—CHECK, <br /> Date Testiong Convac or C <br /> 1819 4148139888 271 ITY ST., C, <br /> Senal No.of Therrnki Technicians Address <br /> Sensor <br />