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Data Art for Tank System Ti htlIss Test <br /> F.I F p - <br /> Y 9 <br /> PLEASE PRINT CK 1r. <br /> 1. OWNER Property ❑ RMC LONESTAR PO BOX 5252, PLEASANTON, CA 94566 <br /> TO Name Address Representative Telephone <br /> anks) 909-815-1454 <br /> Name Address Representative Telephone <br /> 2. OPERATOR RMC IMSTAR SOUTH TRACY BLVD., TRACY, CA 94566 <br /> Name Address Telephone <br /> 3. REASON FOR REGULATION GOVERNING UNDERGROUND STORAGE OF HAZARDOUS SUBSTANCES <br /> TEST SUBCHAPTER 16 OF CHAPTER 3 OF TITLE 23 OF THE CALIFORNIA ADMINISTRATIVE CODE <br /> (Explain Fully) <br /> 4. WHO REQUESTED OWNER <br /> TEST AND WHEN Name Title Company or Affiliation Date <br /> Address Telephone <br /> S. WHO IS PAV,!.%G Ota - <br /> FOR THIS TEST? Company.Agency or Individusl Person Authorizing Title Telephone <br /> Billing Address City State Zip <br /> Attention of: Order No. Other Instructions <br /> Identify by Direction Capacity Brand/Supplier Grade Approx.Age Steel/Fiberglass <br /> 6. TANK(S) INVOLVED EAST/WEST 1,000 UNLEADED <br /> Location Cover Fills Vents Siphones Pumps <br /> 7. INSTALLATION WEST OF EARTH 411 OVERFLOW 111 SUCTION <br /> DATA SCALE HOUSE BENNETT <br /> North inside driveway. Concrete.Black Top. Size,Titefill make,Drop Suction,Remote. <br /> Rear of station,etc. Earth,etc. tubes,Remote Fills Size.Manifoldad Which tanks? Make if known <br /> 8. UNDERGROUND Is the water over the tank? <br /> WATER Depth to the Water table ❑ Yes 1:1 No <br /> Tanks to be filled hr. Date Arranged by_ <br /> 9. FILL-UP Name Telephone <br /> ARRANGEMENTS Extra product to"top off"and run TSTT. How and who to provide? Consider NO Lead. <br /> Terminal or other contact <br /> for notice or inquiry <br /> Company Name <br /> e <br /> 10. CONTRACTOR. Pill <br /> MECHANICS, <br /> any other contractor <br /> involved <br /> 11. OTHER RETEST' <br /> INFORMATION pFAMITISERVICFS <br /> OR REMARKS SAN JOAQUIN COUNTY. <br /> Additional information on any items above.Officials or others to be advised when testing is in progress or completed.Visitors or observers present <br /> during test etc. <br /> Tests were made on the above tank systems in accordance with test procedures prescribed for Petro Tlf! <br /> 12. TEST RESULTS as detailed on attached test charts with results as follows: <br /> Tank Identification Tlght Leakage Indicated Date Tested <br /> UNLEADED TIGHT —— 03-24-89 <br /> This is to certify that these tank systems were tested on the dates)shown.Those indicated as"Tight'meet the criteria established by <br /> 13. CERTIFICATION the National Fire Protection Asociation Pamphlet 329. <br /> 03-24-89 CLINTON DENMAN PETRO—CHECK, INC. <br /> Date Testing Contractor or Company. By: Signature <br /> 1819 4148139888 271 OPPORTUNITY ST., STE. C, SACRAMENTO, CA 91938 <br /> Senal No of Thermal Technicians Address <br /> Sensor J <br />