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Tank and Monitor Summary <br /> Location Pacific Bell Geo/Parcel- UE-046 <br /> Address 907 Lincoln Rd CLLC: SKTNCA11 <br /> City S Tank# 805 <br /> County San Joaquin Tank Permit#-QD13jj— <br /> Zip 25202 Expiration Date_NajQngjjtjQ__ <br /> Inspection Record <br /> Underground Storage Tank <br /> Tank Size: 3500 Sn prod.Dsl 1 level @ test 2 Q 3 2 gal. 4 2 Monitor 4 3 . 7'Stick <br /> Agency requiring Certification: S a n J o a a u i n H e a 1 t h <br /> Agency signature: N/A _required to be on site? No <br /> Required Testing: Tank: X Annual Annually Lines: X Annual Amually <br /> Testing Permit Required Yes X No <br /> Test Type: USP2000P Underfill & Petro-tite line test. <br /> Test Date:_ 9Z1 9Z95 <br /> Test Performed By: Company Dialysis Company <br /> Contact: James and Tamara Zimmerman <br /> Phone Number- (800) 227-7879 <br /> Tested By: James Zimmerman license# 90-1180 <br /> Test Results: P a s s e d Pass/Fail <br /> Remarks: 1Z3500 gallon single wall tank & Product line, <br /> Both were found to be tight . Stick reading shows 21, of <br /> water in tank. <br /> Monitoring System <br /> Manufacturer:—Veeder Root Model: TLS-250i <br /> Agency Requiring Certification San Joaquin Health <br /> Agency Signature: NZA Required to be on site? No Date: 9/19/95 <br /> Required Testing: X Annual Semi-Annual Annually <br /> Testing Permit Required: Yes x No <br /> Test Type: Annual monitor test <br /> Test Date: 9Z19/95 <br /> Test Performed By; Company Dialysis Company <br /> Contact: James and Tamara Zimmerman <br /> Phone: (800) 227-7879 <br /> Tested By: James Zimmerman <br /> Test Results: p a s s Pass/Fail <br /> Remarks: Certified one TLS-2501 console the panel & <br /> Qggbg were found to be functioning per manufacturers <br /> Date of Next Test: 9/19/96 <br /> Ser. # <br />