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reg` TANK CERTIFICATION <br /> TEL-A-LEAK It NDERGROUND TANK TESTERS, INC. <br /> REPORT <br /> 917 W. Belleview a Porterville, Ca 93257 <br /> Phone(209)781-6508 <br /> OWNER'S Property C I PL YZA& I AI C. <br /> NAME Tank(s) Home Q LycJSA[ &4m t a7'o �O/} i'! �O � �• � Tel none s <br /> Address City Zip <br /> NAME OF 4 <br /> Allows <br /> Narne ThOte <br /> LOCATION "f <br /> Address City Zip County <br /> ' NOTICE TO OWNER:A copy of all test results have been filed with the proper regulatory agency governing underground <br /> storage systems. Yes W'.No ❑ If not filed, see explanation below: <br /> APR 15 tont <br /> ENVMROTIMMRAL HEA ,'rW <br /> P 111T/SERVICE$- r <br /> Location of agency where filed: Z'+ <br /> 31"OGK r isle. <A , q $l©5 A r r Ai C°A C.4 L 0-1- 2j <br /> REASON FOR <br /> TEST <br /> (Explain Fully) NOTICE It is the owner's responsibility to contact the environmental health department of any failures within 24 firs.of the results ` <br /> given to the owner. <br /> WHO REQUESTED game Date <' <br /> TEST AND WHEN? T ` cat ro S Zoe ty <br /> py Address elephone <br /> olid ow lWfrection Capacity &and/Supplier Grade A(pprox.Age Steel Fiberglass <br /> tf known) <br /> ITEM OR SYSTEM TESTED <br /> TANK ONLY 10000 C.M ax it o*4%o 1 VJ ❑ ❑ <br /> PRODUCT LINE D ❑ ❑ ;« <br /> VENT LINE ®'" ❑ ❑ <br /> VAPOR UNE ❑ ❑ ❑ <br /> ALL OF THE ABOVE o <br /> FILL-UP Tanks tobe filled !�- �1�_M. <br /> t,l-11- 1/ Del , <br /> ARRANGEMENTS Distributor Name <br /> Extra product to"top oIr YES NO t <br /> OTHER V e Alr L t -� /A/ <br /> INFORMATION <br /> OR REMARKS <br /> Additional information on any items above.Officials or others to be advised when testing is in progress or completed.Visitors or observers present during <br /> test etc <br /> Tests were made on the above tank systems in accordance with TEL-A-LEAK Detection test procedures prescribed for as detailed on <br /> TEST RESULTS attached field sheets with re,-ults as follows <br /> Tank Identification N Tight Tank Tight Lino 1,eakrate Wioll"led Tank Leakier*Indicated Line(e) Data Tested <br /> TANKS Yes ❑ No ❑ Yes ❑ No ❑ <br /> t/_.7! <br /> PRODUCT LINES 0-'-' Yes ❑ No o Yes ❑ No ❑ <br /> Vepet^$Vent Yes r Yes ❑ No ❑ Yes ❑ No ❑ <br /> Lines Included No❑ Yes ❑ No ❑ Yes G No ❑ d <br /> Yes ❑ No ❑ Yes ❑ No ❑ <br /> r <br /> CERTIFICATION This is to certify that these tank systems were tested on the dates) shown. Those indicated as"Tight"meet the criteria established by <br /> the National Fire Protection Association(Pamphlet 329). 9 <br /> Dat <br /> CA '911-e 1000 DENNIS E.GOODAN r � <br /> ." - . <br /> t <br /> TEL-A-LEAK I Tu operator UNDERGROUND TANK TESTERS,INC./By:Signature <br /> .P . <br />