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Tarok Te*,.,I ng' <br />Phone (209) 931-1828 <br />!V Post Office Box 3048712AP vnsed <br />Slo,cl,do,n. Callfofnla 95213 LICENSE *92 - inured <br />1?1;1 '01 <br />I OWNER OF SITEJ SS <br />: <br />F0 :1 <br />ADDRESS: <br />�__c ITY: <br />OWNER, OF TANKS: <br />ADDRESSt[TY - -- -- --- ----- <br />.OPERATOR AT LOCA,rION:— <br />ADDRESSi <br />_c UP y - ZIP: <br />COUNTY I <br />TANK <br />_A(-, E. 'AL <br />j. <br />;HETAL(A) FIBERGLASS( <br />13 14 A 1, f, F: 1.) (y) <br />I)OU131d; wAI,I,r.l)( <br />DIESEL( UNLEADEDQ() <br />�.,WASTE OIL( KEROSENE( AVIA'111()Ij FUEL( <br />­,SUCTIONO<) SUBMERSIBLE( <br />"'!SHEAR'JVALVE--YES( N0(X) IN <br />N <br />-'VAPOR RECOVERY SYSTEM--YE.c;(X) NO( <br />1111ASE I QCy 1) 11 AS E 7, <br />TANK, -FILL DATE 5ILL-1-c Timr,- -7 <br />NK. TEST DATE: <br />( TA <br />:j -!Y-ZZ_93 STAR,r.- 085-7 <br />7 ,LING II OF TI'st, <br />fl,TANK..130TTOM To G IZADE <br />'v I <br />"I -) <br />TANK: TOP To GRADE ....... <br />__,3_3_ P f) I J 111.) 1-1 Al F R AFITANK OVr, TANK. <br />DIAMETER ................ cly <br />. . . . . . . . . . . . . . . . <br />�-ll TEST LEVEL ABOVE GROUND <br />NET 111T."IT S Li I? E__:!Z- A -k—) <br />�'IiWATER IN TANK . . . . . . <br />. DEPTH FOR TARIlq(l, <br />TEMPERATURE PROBE DEPTI1. 60 <br />IT (:PAV 0, <br />I;: x 1'. <br />,CERTIFIED TIGIIT--YES(X) NO( ....... <br />PRODUOT LINE TESTamjPAS.9(X) I` A 1. L <br />CERTIFIEDTIGHT--YES(X) <br />No( <br />COMMENTS: <br />DATki 13 <br />SIGNATURE or <br />m <br />