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Jun 29 04 11:02a WEST STFlR (559)277-0106 P.1 <br />.6 # <br />M9 B{n <br />3JJ PEt ME: M s t: R <br />`lfflM[M/M[Nil 1111 E S TAR 7Fp,Elr <br />EN NMENT INC. <br />SALES - UCTION - SERVICE <br />46$$ W. 7ENN , $TE 101, FRE NO, CA. 93722 <br />(559)27 37$554)77-0106 <br />INSPECTION REQUEST <br />NOTE: INSPECTOR, TO CONFIRM TEST PLEASE INITIAL AT BOTTOM OF PAGE AND FAX TO (559) 277-0106 <br />Date: 6/30/2004 Fax Number: 209-468-3433 <br />Attn: RAY VONFLUE Conf, #: (If necessary fill in <br />Facility Details and fax back to Stenya @ 559-277-0106) <br />Permit # <br />Facility Name: ESCALON MINI MART <br />Facility Address: 1097 E YOSEMITE <br />City: ESCALON Zip: <br />Telephone: 209-838-1546 Fax: <br />Contact Name: SILL Title <br />Schedule Type: Facility Start-up <br />Routine Compliance <br />Retest <br />Reschedule <br />Testing Company Details <br />95320 <br />OWNER <br />Cancellation <br />X Annual Monitoring <br />Cathodic Protection (if applicable) <br />Testing Company Name: WSE <br />Testing Company Address: 4688 W JENNIFER #101 <br />City: FRESNO,CA Zip: <br />Telephone: 559-277-9378 Fax: <br />Tester's Name (Print): Tester's ID #: <br />Requested By: <br />2d Nnur Tact Parer rite <br />STENYA MENDRIN <br />93722 <br />559-277-0106 <br />Test Time: 7-8-04 @ 9 AM <br />Test Test Scheduled Pass Fail <br />TP 201.3 Leak Decay <br />TP 201.38 Leak Decay (AST) <br />TP201.4 Back Pressure <br />TP201.5 Air to Liquid Ratio <br />TP201.6C Liquid Removal <br />VRI 01 Ex 4 <br />VR101 Ex 5 <br />VR102 Ex 4 <br />VR102 Ex 5 <br />Annual Monitoring X <br />TP201.3C UST Tie Test <br />MLLD Mechanical Line Leak Test <br />LINE TEST Pressure Line Test <br />UST Integrity Tightness Test <br />STest I <br />,Cathodic Protection <br />X10(1, <br />Comments: <br />Date Received: Inspector acknowledgement: <br />