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CRISP TANK TESTING Test Rer�Vf i <br />;40 W. ALDER <br />STOCKTON, CA 95204 Underground Storage Tani <br />HORNER SYSTEM <br />OWNER OF SITE PRRKER hcA.ee� 7 - <br />ADDRESS OF OWNER /.90, dox �'/�O C I TY STAT E Z 1 P '?52pe <br />OWNER OF TANK PARKE,< cY /Z.9,Pee✓ 41nLT. <br />ADDRESS OF OWNER %1 c-2, BOX _C I TY SG�dlJ _STATE C,�q Z I P 95Zo8 <br />NAME OF OPERATOR AT LOCATION Sovr/, BH✓ 71.1E eTeuce STOP <br />ADDRESS OF LOCATION 16 -01 CEJ (: 9,A �44Z CITY ,S'7zac,&7b,/ STATE C,4 ZIP 95Zd6 <br />NAME OF COUNTY r-S�Aj oAQv,.0 <br />TANK ON PLOT PLAN LOCATION. STORAGE SYSTEM FILLED; DATE /// - TIME /,R6io <br />DATE OF TEST TIME OF DAY: START % p p FINISH /�,1 /6 <br />LENGTH OF TESTa/� J�,l�„„J . AIR TEMPERATURE_ 0/0' <br />DISCRIPTION OF TANK -CAPACITY poo DIAMETER ��METAL X FIBERGLASS _ <br />TYPE OF SYSTEM- SUCTION__SUBMERSIBLE OTHER <br />TYPE OF VAPOR RECOVERY SYSTEM NOA/E <br />TYPE OF PRODUCT BEING TESTEDREQU:.AA, MEASRURED GRAVITY 6 p, ps COEFFI C i ENT. Uoo6p <br />TEMPERATURE OF PRODUCT —70 - <br />MEASURED 4fATER IN TANK 2 DEPTH OF TANK TOP FROM GROUND LEVEL e��2 <br />DEPTH OF GROUND WATER l -/O F7- HEIGHT OF LIQUID LEVEL IN TEST STAND OR STAND PIPE <br />AGE OF TANK AND LINES U^)jGn/o&)^/ <br />RESULTS OF TEST: CERTIFIED TIGHT: NO IF NO EXPLAIN IN REMARKS BELOW <br />LEAK RATE PER HOUR: <br />REMARKS BY OPERATOR <br />A <br />-- ENVIRO OE,I,TAL HEALTH <br />LhilrfftERVIGEG <br />NAME OF OPERATOR �Epir/,q/2D C'2i5� <br />it <br />SIGNATURE OF OPERATOP <br />DATE /���� <br />