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.crisp <br />�Tanlc Tis C01-ISIFLIC A company <br />1•.. p.-,. -4 w E: ,tic-. <br />.M1o11A (409) 934 4626 DEC <br />� w;�xf� licensed <br />Post office Sox 30487 2 3 19,92I sured <br />• PocMw% ColUornla 95213 NV{ ? i 1w�,, TA�. HEALTH LICENSE #92-124 <br />PER31llli5E81"t'(�►t'r* LEONARD E. GRIP <br />k ..: <br />OWNER 0E SITE <br />ADDRESS A co RLQ SUN T (' 1.'I' Y : � ('t' K t v �. i�=J.�.L <br />OWNER- OF TANKS: ------- <br />ADDRESS t _ C IT : _ ____...... <br />----- _ ► �__�, I r <br />OPERATOR AT LOCATION: _ _-_�Mk=-_--_----_-------------- <br />ADDRESS $l - ---CITY ---- ------ --- --- ' — ---7, l [' <br />COUNTY t�j�AT�J( nl 'TANK if _�`n(,1:: <br />METAL(.y) FIBERGLASS( ) 51 r1►:I,r w>\I,t,Et►(K) r�oul3t,r: rrnr,LF.I)( ) <br />DIESEL( ) UNLEADED( ) r'tzrrtlrlrl 1)1JI,r:n1►F.I)( ) �LU-5 -(y) <br />j WASTE OIL( ) KEROSENE( ) AVIATION (;n ; ( ) 1 P:'I' FUEL( ) WA'I'FR ( ) <br />SUCTION( ) SUBMER5iI3LE(�O (►vr:lisrrl,l, r.(►rrrnlrarh--YE��(X) No ) <br />SHEAR':VALVE--YES(() No( ) IN I,I 111: 1,1;111; Lil{'I'I:i:'1'(►(t --Y1; ;(�) N(?( ) <br />VAPOR RECOVERY SYSTEM --YE (�) NO ) I r YF,-, PHASE I (X 1 I'lI V,F 7.(Y) <br />TANK FILL DATE: it I92-'rlrtF.: — <br />TANK TEST DATEt i I -r' - ZsrART: pl y r.Nl►: U �` 1,ENGITH OF TEST'2 <br />. TANK BOTTOM TO GRADE .... '1'0 'rnrJt; 110,11,110H <br />TANK TOP TO GRADE....... �_ (;R()tlIII) rdn'I F." A13OVE 'TANK.. - <br />DIAMETER. ,,....... ......_C%(� _ I'` i .................... • _ <br />TEST LEVEL ABOVE GROUND. 25 i rJF,'r TET 1"RESSURF........... <br />WATER IN TANK.......... AI'I f;l'F.0 GRAV........... <br />DEPTH FOR TAKING SAMPLE._ ............... .. . <br />'::.'CEMPERATURE PROBE DEPTtI._� <br />API SPEC(;tJAV (� 601I'...•. <br />j. <br />C0 I" I' L(: t 11"11 IT OF E X I' ......... <br />i' 4CERTII;IED TIGHT--YES(-i) NO( ) I.I'.ni; I?n11: <br />�x; f <br />PRO'DUOT LINE TEST--PASS(X) FA i L ( ) `;UG:'I' 1 r►tJ ( ) I'[2 E5 ;I►I21: (X) <br />! CERTIFIED TIGIIT--YES( () Not ) r,FAK TWIT r'I IZ/utr: 1 -0--=_.I <br />; p��•t' bATEt ll 7 9c S10NATUR1 of '1'Ef 'i 1:12 t '� <br />d •' <br />t,4 ' COMMENTS t <br />�''� : REV 3/92 -------_--.___.__ <br />