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P.-O. BOX 30457 1 wnim <br /> Stocktnn , California <br /> (209) 931-1528 <br /> rLST kr,rorz-r <br /> LICENSE #92-1248 <br /> LEONARD E. CRISP <br /> owrirR or s�TF_�/Y) �fz_ 4(� 61, <br /> AUUfiESS j <br /> �" L �` 1U x 1��� CITY �Q STA1ZIl'9 �� <br /> OWNER OF T�1NI<s V .i - <br /> ADDRESS <br /> —i-, CITY STATETA ZIP <br /> OPERATOR AT LOCATIOFJ_/e,= cv <br /> ADDRESS� ? <br /> A' CITY ,t STATEA_ZIP�( �� <br /> NAF-IE OF COUNTY - ln L <br /> TANK �1 { _ UN PI. PLAN. AGE OF TANK <br /> DESCRIPTION Or TANK: <br /> CAPACITY L C) DIAMETER <br /> � _ HETALY.FIBERGL.ASS <br /> TYPE OF SYSTEM; SUCTION ; SUUFERSIDLE -; <br /> VAPOR RECOVERY SYSTEM? �C OTHER <br /> PRODUCT DE114G TESTED -�-- T TYPE <br /> 11 MEASURED WAVITY /� �J • <br /> API SPECIEIC GRAVITY 0 60OF - <br /> r'}iODUC 1 , TEMP. ' <br /> S101?AGE SyySTEErr1: �-� •= _ -=-a COE .,1 a:rM • ,� <br /> F1LLEu - UA-TF T1h1F-'/ 1 11 c� <br /> TESTED - DATE(]- /f� j , SIN �Q�) <br /> LENGTH OF LEST FINISH $ <br /> F•tEASUriEU WATER IN TAhll<___:j2- WI _---• . <br /> GHT OF LIQUID LEVEL <br /> UEP111 OF GROUND WATER— <br /> PSIAT TAFJK OOTTOFd <br /> RESULTS OF TEST ; <br /> CERTIFIED TIGHT? - YES <br /> LEAK RATE PER LIED + "��.'--'-NO 'r IF NO EXPLAIN IN REMARKS. <br /> or <br /> REMARKS BY OPERATOR <br /> tJAhIE OF OPERATOR ?t' f l�L <br /> ;'r" �'�' <br /> SIGNATME OF OPERATOR <br /> DATE_ ; .- cQ1=1�"�S_l./_ _ <br /> . .i <br />