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,. r 'avoyl <br />-PLEASE PRINT <br />1. OWNER Property <br />Tank(s) <br />Data Cart for lank System Tight ss Testi petro Tite <br />`L/ <br />TANK TESTER 1 57 <br />Chevron USA INC. 2 Annabel Lane San Ramon, CA 94583 (415)838-5302 <br />Name _ _ w w - Address Representative Teles <br />2. <br />OPERATOR <br />m Lane Lodi CA f209)334-2241 <br />Name ,Address <br />Telephone <br />3. <br />REASON FOR <br />TEST <br />(Explain Fully) <br />Sher Bill <br />4. <br />WHO REQUESTEDhe <br />TEST AND WHEN <br />rono <br />Nam'Title Compan <br />2 Annabel Lane suite 1200 San Ramon CAFE 83 <br />Aa -11-87 <br />fliliati n Data <br />4 838 <br />Addiess <br />Telephone <br />5. <br />WHO IS PAYINGtolz <br />FOR THIS TESTI <br />'y�T <br />'0<0 neer 415 838-5302 <br />Company, Agency of Indlvidual Person Authorlting <br />IqUit-f- #200 n A 94583 <br />Telephone <br />° <br />Billing Addtess _ city Zip <br />Attention of: Order No. Other Instructions <br />6. <br />TANK(S) INVOLVED <br />Identify by Direction <br />tank #4 <br />Capacity <br />1000 al <br />Brand/Supplier <br />Chveronw <br />Grade <br />teoil di <br />Approx. Ape <br />sl 18yr <br />Steel/Fiberglass <br />steel <br />7 <br />DATA INSTALLATION <br />Location <br />see map <br />North Inside driveway, <br />Rear of station, etc. <br />Cover <br />cement pad <br />Concrete, Black Top. <br />Earth, etc. <br />Fills <br />� <br />3 "" 5Tc k <br />a'Xe1r,E <br />Site, Titefill make, Drop <br />tubes, Remote Fills <br />Vents <br />` / <br />Size, Manifolded <br />Siphones <br />/,) 1A <br />Which tanks) <br />Pumps <br />4,4 <br />Suction, Remote, <br />Make If known <br />8. <br />UNDERGROUND <br />WATER <br />Depth to the Water table ��%`��'"" <br />Is the water over the tan <br />El Yes No <br />.9. <br />FILL -UP <br />ARRANGEMENTS <br />nn <br />Tanks to be filled 8:00 hr. 10- 87 Data Arranged bye PRECISION ENVIRONMENTAL(415)595-1863 <br />Name Telephone <br />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 Telephone <br />10. <br />CONTRACTOR, <br />MECHANICS, <br />anyother contractor <br />involved <br />- - <br />11. <br />OTHER <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 <br />during test etc. <br />12. <br />TEST RESULTS <br />Taste were made on the above tank systems In accordance with test procedures prescribed for ptr0 TIS <br />as detailed on attached test charts with results as follows: ptO <br />Tank Identification Tight Leakage Indicated Date Tested <br />tank 4 ES ': 0 3c') <br />This is to certify that these tank systems were tested on the dale(s) shown. Those Indicated as 'Tight" meet the terla established by <br />13. CERTIFICATION the National Fire Protection Asoclatlon Pamphlet 329. <br />6-18-87 Mark Morrissey AB PRECISION ENVIRONMENTAL <br />Dau <br />Testing Contractor or Company. By: Signal <br />1719 <br />1719 �-�,,, •LSe�,..1081 Alameda De Las PulEs #8 <br />tt. CA 94002- <br />Serial No. of ThermalTechnicians <br />dress <br />Sensor • <br />