Laserfiche WebLink
Data Art rTank System la s Test <br />a-EWIONIS PRECISION <br />PLEASE PRINT <br />1. OWNER Property <br />Name Address Representative <br />Tank(s) <br />Name Address Representative <br />2. <br />OPERATOR <br />5-f zl- <br />Name Address <br />Telephone <br />3. <br />REASON FOR <br />REGULATION GOVERNING UNDERGROUND STORAGE <br />TEST <br />SUBCHAPTER 16 OF CHAPTER 3 OF TITLE 23 OF THE CALIFORNIA ADMINISTRATIVE CODI <br />(Explain Fully) <br />4. <br />WHO REQUESTED <br />9A@fx Filmer Construction 2180 Enterprise <br />TEST AND WHEN <br />Name Title Company or Affdiation <br />Dale <br />Address <br />Telephone <br />5. <br />WHO IS PAYING <br />Filmer Construction Same as above <br />FOR THIS TEST? <br />company. Agency or Individual Person Authorizing Title <br />Telephone <br />Billing Address City State <br />Zip <br />Attention of: Older No. Other Instructions <br />6. <br />TANKS' INVOLVED <br />Identify by Direction <br /><44 <br />Capacity <br />Brand/Supplier <br />Grade <br />at <br />Approx. Age <br />& <br />Steel/fiberglass <br />7. <br />INSTALLATION <br />DATA <br />Location <br />�� x <br />North inside driveway. <br />Roat of station. etc. <br />Cover <br />no.u��cri <br />Concrete. Black Top. <br />Earth. etc_ <br />Fills <br />G� <br />Size, Titefill make. Drop <br />tubes. Remote Fills <br />Vents <br />2 <br />Size. Manitolded <br />Siphons <br />Which tanks? <br />Pumps <br />Suction. Remote, <br />Make it known <br />6. <br />UNDERGROUND <br />WATER <br />Is the water over the tank? <br />Depth to the Water table d EJ Yes No <br />9. <br />FILL -UP <br />ARRANGEMENTS <br />Tanks to be tilled e— n' hr. 'E -23t `Ed' Date Arranged by <br />fi <br />Name <br />Extra product to "top oft- and run TSTT. Mow and who to provide? Consider NO Lead. <br />Telephone <br />Terminal or other contact N 0 T APPLICABLE <br />for notice or inquiry <br />Company Name <br />Telephone <br />10. <br />CONTRACTOR, <br />MECHANICS, <br />any other contractor <br />NOT APPLIUABLE <br />11. <br />involved <br />OTHER <br />INFORMATION.0 <br />— <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 />Tests were made on the above tank systems in accordance with test procedures prescribed for Fsf$ro T–dr <br />as detailed on attached test charts with results as follows: "^ <br />Tank Identification Tight Leakage Indicated I Date Tested <br />.10'- <br />rr • <br />1 <br />This is to certify that these tank systems were tested on the dates) shown. Those indicated as "right" meet the criteria established by <br />13. CERTIFICATION the National ire Protection Asociation Pamphlet 329. <br />5' CH2kNPION i Sy PRECISION TANK TESTING <br />Date ... , �,. . s_... ..__. <br />1451 OAKHURS`I'ti Y lact�Al Com an . e P � n§ 822 <br />v _1 <br />Seng No of Thermal Tech, ans Add—s <br />C.ncn, <br />