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1. OWNER fropeny ❑ <br />Ton*) p <br />2. OPERATOR <br />3. REASON FOR <br />TEST <br />(Explain Fully) <br />4. WHO REQUESTED <br />TEST AND WHEN <br />5. WHO IS PAYING <br />FOR THIS TEST? <br />a <br />Mobil Oil Corporation <br />T5 & Hammer Lane <br />Meme <br />SS# 10992 I-5 & Ham <br />M <br />ockton. CA <br />«4 <br />:ness <br />41 <br />substances, subchapter 16 of chapter 3 of title 23 of <br />California dm n strat on Code. <br />Nick Bokidas General Manager Precision Industries 6 <br />W.— TWO CONOMW a Alalraon <br />No. <br />ly/ <br />992-99 <br />tT, <br />992-99 <br />T9 <br />997_99 <br />Identify by Direction <br />capacity <br />Mand /S far <br />Grads <br />Appro:• Age <br />Stas►/Fdwglas <br />6. TANK(S) INVOLVED <br />10.000 <br />AA0hI <br />Super <br />A-7'&C402� <br />10 000 <br />t( '' <br />Regular— <br />- <br />�# <br />10,000 <br />u <br />Unleaded <br />6-7 Yrs. <br />`J <br />Location <br />Cover <br />�� <br />Fick <br />Vents <br />6whona <br />6n\b <br />7. INSTALLATION BAST W7F <br />v <br />Etouft�_ qr <br />icC-f <br />DATA 8Ji l D <br />tin"' <br />2jaz: <br />North hu"s drivewsy, <br />Neer of station, v <br />Concrete. Wet Tep. <br />Earth. Me. <br />sits. TiWIN mets. Drop <br />tubs. Item are FM <br />airs. ManMolded <br />WWeh ranks? <br />suction. throats. <br />Mats It known <br />6. UNDERGROUND le)O D,t,,) . etc 3ofbm " " "] Yes �y " <br />WATER Depth to the Waw table ❑ [5 <br />8. FILL -UP <br />ARRANGEMENTS <br />10. CONTRACTOR, <br />MECHANICS, <br />any otMr contractor <br />Involved <br />11. OTHER <br />INFORMATION <br />OR REMARKS <br />12. TEST RESULTS <br />n <br />Tanks to be fikd hr. Date Arranged by <br />Fume Toophons t <br />Extra product to "bp off.. and run TSTT. Now and who to provide 7 Corks" NO lead. 1 <br />Mobil Transportation to top off <br />Terminal or other contact e <br />for notice or inquiry Now Tel"A N ! <br />Cempsnr. <br />-PRE <br />c c o --LN-0 <br />Additional information on any hems shove. Oft" omens to <br />during test su. <br />progress or GW*"ted. visitors or ooservers present <br />Taft lawn rade on Mks show tank systems In t ceordows with lost proosdurso p ut ilsor w4roj� <br />wt do Wisd on ahacltad Not O wts with results IM 10110 : <br />Tank Identification Tight Leakage Indicated Dau Tested <br />IJt'XZ 1 <br />pin-, Jl. lnLw(_ UFr5 •AlQ U Dc\(o <br />2 M\0 fjLktt Ih C 011 C kV -5c � A tt2 V cY <br />vewkc,( t $ <br />Thk M to osttty MSM Moos fork systorm more Seated on vw deWs) Hawn. Thoth Ntdicstsd ss •7W' tseW Mn whorls swiablishod by <br />13. CERTIFI TION Mw Noww firs frolsodon A000lation laetphist M. <br />SII �4g,� ENVG;O;MENTALPETCOLEUMENGN. __4.� <br />oer TO. BOX 076. STOC s"Ma ny. IN: nawre <br />11 , tt5(4WiZc7b�✓) CxS(j'� <br />SWW ND M TMrnW Mhrutune r� <br />Barra <br />