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ADDRESS: CITY: kfT)V)_, A Z I P <br />OWNER OF TANKS: cl's atie) <br />ADDRESS: CITY: —r—ZIP: <br />OPERATOR AT LOCATION: <br />ADDRESS: CITY: <br />COUNTY:( �MQJAjja, TANK # AGE: GALLONS: <br />- v <br />METAL(V,) FIBERGLASS( ) SINGLE WALLED(V) DOUBLE WALLED( <br />DIESEL UNLEADED( ) PREMIUM UNLEADED( ) <br />WASTE OIL( KEROSENE( AVIATION GAS( ) JET FUEL( WA,rER( <br />SUCTION( ) SUBMERSIBLEV,) OVERSPILL CONTAINER --YES( NO(V) <br />SHEARVVALVE--YESf,�/) NO( ) IN-LINE LEAK DETECTOR--YES(QC) NO( <br />.VAPOR RECOVERY SYSTEM--YESW3,,NmO( ) *IF YES, PHASE 1( PHASE 2( <br />kc <br />TANK FILL DATE: )?J-22-16JIME: <br />TANK TEST DATE: TART: END: LENGTH OF TEST., <br />TANK BOTTOM TO GRADE...._J_w, TEST LEVEL TO TANK BOTTOM <br />TANK TOP TO GRADE ...... GROUND WATER ABOVE TANK.. - <br />DIAMETER..... 66 ....... PSI ...................... <br />TEST LEVEL ABOVE GROUND. NET TEST PRESSURE ........ <br />WATER IN TANK........... API SPEC GRAY........... <br />DEPTH FOR TAKING SAMPLE. TEMP ..................... .. 471 <br />TEMPERATURE PROBE DEPTH.,�_ API SPEC GRAV @ 60' F.... .5 <br />COEFICIENT OF EXP <br />'CERTIFIED TIGHT--YES('A NO( LEAK RATE PER/11R:+ <br />PRODUCT LINE TEST—PASSM) FAIL( <br />CERTIFIED TIGHT-_YESVJ NO( <br />COMMENTS: <br />DATE: -7/0- <br />SIGNATURE OF TEST <br />REV 3/92 <br />SUCTION( ) PRESSURE() <br />LEAK RATE PER/HR:+ <br />risp Tank <br />Olin," 'ft <br />ie a <br />'d""onstruct4n <br />Company <br />one (209) 931.1828 <br />Licensed <br />Pod 011111ce Box 30487 <br />Insured <br />Stockton, California 95213 <br />LICENSE #92-1248 <br />**TEST, REPORT** <br />OWNER OF SITE, <br />(Ixm <br />c- k _*vmoy <br />LEONARD F. CRISP <br />ADDRESS: CITY: kfT)V)_, A Z I P <br />OWNER OF TANKS: cl's atie) <br />ADDRESS: CITY: —r—ZIP: <br />OPERATOR AT LOCATION: <br />ADDRESS: CITY: <br />COUNTY:( �MQJAjja, TANK # AGE: GALLONS: <br />- v <br />METAL(V,) FIBERGLASS( ) SINGLE WALLED(V) DOUBLE WALLED( <br />DIESEL UNLEADED( ) PREMIUM UNLEADED( ) <br />WASTE OIL( KEROSENE( AVIATION GAS( ) JET FUEL( WA,rER( <br />SUCTION( ) SUBMERSIBLEV,) OVERSPILL CONTAINER --YES( NO(V) <br />SHEARVVALVE--YESf,�/) NO( ) IN-LINE LEAK DETECTOR--YES(QC) NO( <br />.VAPOR RECOVERY SYSTEM--YESW3,,NmO( ) *IF YES, PHASE 1( PHASE 2( <br />kc <br />TANK FILL DATE: )?J-22-16JIME: <br />TANK TEST DATE: TART: END: LENGTH OF TEST., <br />TANK BOTTOM TO GRADE...._J_w, TEST LEVEL TO TANK BOTTOM <br />TANK TOP TO GRADE ...... GROUND WATER ABOVE TANK.. - <br />DIAMETER..... 66 ....... PSI ...................... <br />TEST LEVEL ABOVE GROUND. NET TEST PRESSURE ........ <br />WATER IN TANK........... API SPEC GRAY........... <br />DEPTH FOR TAKING SAMPLE. TEMP ..................... .. 471 <br />TEMPERATURE PROBE DEPTH.,�_ API SPEC GRAV @ 60' F.... .5 <br />COEFICIENT OF EXP <br />'CERTIFIED TIGHT--YES('A NO( LEAK RATE PER/11R:+ <br />PRODUCT LINE TEST—PASSM) FAIL( <br />CERTIFIED TIGHT-_YESVJ NO( <br />COMMENTS: <br />DATE: -7/0- <br />SIGNATURE OF TEST <br />REV 3/92 <br />SUCTION( ) PRESSURE() <br />LEAK RATE PER/HR:+ <br />