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Jet q 7F <br />�A s1rucii Company <br />iris , ank 7c n i mai Y <br />;1 phone (209) 934.1626 s licensed <br />;holt OMlae box 30462 Insured <br />. loe t% Carlilornla 95213 - _ 9 sip q7 r <br />.► i **TrS'I' VETE►I2+'1'# k <br />LEON14." 7) E: CRISP M <br />OWNER OF SITES. <br />r ADDRESS 241 _ E__mQ IT Ci'ry .._ f�'�Tt� —_ _ CA 5 2 - <br />>t <br />OWNER. OE TANKS: <br />ADDRESS! _ CITY: _ �► ZI [' <br />• `," OPERATOR AT LOCATIONS MS <br />tADDRESSI CITY:_ <br />F COUNTY _'� )lnl 'T <br />:1 ANK _____M3r : _GALLONS : _ <br />METAL( ) 1+IBERGLASS( ) 5l.Nr:l.,l; wni,l,r:i)(�) hr)I1llt,r IJALl�rl1( ) <br />'`bii3SEL(�C) UNLEADED( ) PREMrUI1 UNt,rnfMu( <br />.' WASTiE' 0IL( > KEROSENm ,) AV I A'r r c►N (',As( ) .f r ,v r•t;Er,( ) WAIT 11 ) <br />'SUCTIONt ) SUBMERSIBLE(N) oVl;it P11�rl,t, �rrrntr'fra--Yr.stx) rrr�( ) <br />SNEAR' VALVE-�YES(x) NO( ) IN LINE, LFAf; r,f:'rr.("rc►fi- Yr::; ) No( ) <br />?,:�:.vAPdR RECOVERY SYSTEM --YES ( ) NO9<) E 1 1` Y t;'; , VIIASr 1 ( 1 f'11A ;r <br />Ia .. <br />. ' V. <br />TANK 1 ILL .DATE: jI Z'r1 Ft f3 : (DC7 <br />k s,. 2 <br />t .«'CANK,TEST; DATE: 11 17-%ZSTAlrr:_(( p rND- /. _r,rNr'rrr E►e 'rrST! � <br />S <br />♦ ♦ TANK:-BOTTOM TO GRADE... 1 3 — rf.�;'r I,r:vr•,(, TO 'TANK 110TTOM <br />k 1 TANK';TOP TO GRADE.. a6 _ (,MMIN1► WATE'll ABOVE 'TANK . . <br />{ � ti a : b I A M E'C E It 1 1 . . 1 . . . . 1 . . . . . . C/� _ 1 ' : i . • ... • .. ♦ • • • .. a ... • . • _ _, <br />TESV11EVE1, ABOVE GROUND. 20 rtr'r 111r;'11 ITES5URE........ <br />!,,WATER,-.,IN :TANK ........... API SPEC GMAV .... , ....... 33.5• <br />r' {r,bEPTNt FOR TAKINO SAMPLE �j� 0 <br />< 'I' I :Pi 1 .................... <br />{'i° , 'CEMpERATURE PRO136 DEP'rll._ All] SPEC GHAV @ 601 r• • .•• 3,�5 <br />V � �l (if r.1 r: r faa'r OF Exp... 04; 67 <br />J <br />F� <br />CERTIFIED TIGIIT---YES(?() NO( ) LEAK iwrr, 1'Ctt/11111 <br />PROOtJOT; LINE TEST-- PASS()(-) FAIL( ) SUCTION( ) Pt:rsstinE(";;,C) <br />;CERTIt1:IED TIG11T- YESO() i NO( ) LEAR VATS, 111,"R/11111_1 <br />' L ' <br />DATEt� �� _/-2 SIGNA'1'll[2E Uf' <br />"; • COMMENTS e L, /ft- L/ Ne 4-EAK <br />r ; <br />♦ <br />r Y <br />, it'd-.______.--.._._•_ __ .___.___.....__.—..—_..—._..___.._ �...—. — _ 1 <br />,:. • REV, 3/92 <br />ii <br />1' <br />