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6. INSTALLATION <br />DATA <br />7. UNDERGROUND <br />WATER <br />8. FILL -UP <br />ARRANGEMENTS <br />txdian Cover <br />ate. hart for <br />TankSystem Ines F: <br />fes,. <br />�aFnT <br />5't oRe <br />4!/ <br />.EASE PRINT <br />Site. Tetdia mese. 0,00Ra <br />1. OWNER <br />lubes. Remote Frs <br />N+v <br />❑ <br />seems, Address <br />Lip Re,7reeenta .Aeroel— <br />Tr.sts 1 <br />Y9- <br />Items Addr.as <br />P -p Regrown itty— Teeonpe <br />'&'IEZ i) <br />2. OPERATOR` <br />roma Address <br />Zip Twonons <br />3. REASON FOR <br />TEST <br />16 OF CHAPTER 3 TITLE 23 OF THE <br />CALIFORNIA ADMINISTRATIVE CODE <br />(Willits Fuftj <br />4. WHO REOUESTED <br />TEST AND WHEN <br />"r"e Toa <br />cdrnp.rh,«AMdnran pros <br />Addrw <br />AO Yae+drsone <br />-warrary b, Direction capacity <br />®rwWl$upph« <br />toad. Approx. Acte stealIF.Wrgless <br />5. TANK INVOLVED <br />`S ti <br />' " t 5T., I—rJ . <br />the additional Pried <br />- <br />br mdrritclow tanks <br />6. INSTALLATION <br />DATA <br />7. UNDERGROUND <br />WATER <br />8. FILL -UP <br />ARRANGEMENTS <br />txdian Cover <br />Fins <br />Vents <br />�aFnT <br />5't oRe <br />4!/ <br />"prat inside «ive.ssy. Concrete. 8taek Tom <br />Site. Tetdia mese. 0,00Ra <br />w of station. etc. Earth. <br />lubes. Remote Frs <br />Ste. Mamfotded <br />Depth b Mee ®iter table horn grade <br />Sipanes pumps <br />GSPA k�-r <br />Suction. Remote. <br />VNnich tants? Make it known <br />Is the viler over, the tank? <br />EIV. ❑ No <br />Tanks to be reed =.Q—hr.-6�2Ore Arrsngaid by Name Telephone <br />Entre product to lop of arAnan tank tester. (tow and who to provide? Consider NO Leen. <br />h <br />Ywn nd or other contact <br />he wive or irawky <br />9. CONTRACTOR. <br />MECHANICS. <br />any other contractor <br />Involved <br />10. OTHER <br />INFORMATION <br />OR REMARKS <br />Additional information on any items above. 011iciats of otters a be advised when testing is in progress of compMed. Visdon or observers present during test, we. <br />11. TEST METHOD PETRO TITE ❑ PETRO COMP ❑ QUICK CHECK 2000 <br />Tests seer® madabove e on the abe tank systerne 1n ai=weunu earth teat procedures preo <br />scribed t <br />112. TEST RESULTS <br />a detailed of attacMd test t.twU wtth results As follows: <br />Tens grhtitirat:an Tigris No Volume Change Per 14MO Dole Tested <br />VIES - <br />h <br />12. SENSOR <br />CERTIFICATION <br />P • 73 ®�r''l� <br />Data <br />Stew No. N Thienew <br />13. CONTRACTOR CERTIFICATION <br />>Jedaeicisnn <br />c.Mttvaiere. <br />CHAMPION'S PRECISION TANK TESTI6W--- --- <br />Teasing C-- w Comyeny. by: sww%" <br />P.O.-BOX 13059 SACRAMENTO, CA. 95813-3059 <br />1-800-660-9443 <br />. - tnf+6l27 <br />