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. 1, <br />0 <br />Tank and Monitor Summary <br />Location <br />-Pacific Bell <br />Geo/Parcel- <br />UG -010 <br />Address <br />1812 Coley Ave <br />CLLC: <br />ESCLCA11 <br />Ciry <br />Escalon <br />Tank# <br />794 <br />County <br />San Joaquin_ <br />Tank Permit # <br />0003555 <br />Zip <br />9 5 3 2-Q: <br />Expiration Date 12131Z95 <br />Inspection Record <br />Underground Storage Tank <br />Tank size: 500 Db prod. Ds 1 1 level @ test -2,6-2 szal. 2 3 . 9 Monitor 2 5 Stick <br />Agency requiring Certification: San Joacj-uin Health <br />Agency signature: N/A --- - - - _required to be on site? No <br />Required Testing: Tank: No Annual Annually Lines: NO Annual Annually <br />Testing Permit Required Yes XX No <br />Test Type: NZA <br />Test Date: <br />Test Performed By: Company Dailvsis Company <br />Contact: James and Tamara Zimmerman <br />Phone Number (8001 227-7872 <br />Tested By: license # <br />Test Results: Pass/ Fail <br />Remarks: Tank and Line testing are not required on a double <br />Lidjj system ger Agency, follows State <br />Monitoring System <br />Manufacturer: Veeder Root Model: TLS -250i <br />Agency Requiring Certification San Joaquin Health <br />Agency Signature: N/A Required to be on site? NO --Date:-2-Z2,0/95 <br />Required Testing: XX Annual Semi -Annual Annually <br />Testing Permit Required: Yes XX No <br />Test Type: Annual MQ12itog lest <br />Test Date: ,9Z20/95 <br />Test Performed By; Company Dialysis Company <br />Contact: James and Tamara Zimmerman <br />Phone: (800) 227-7879 <br />Tested By: James Zimmegman <br />Test Results: P a s s Pass/Fail <br />Remarks: Certified one TLS -2501 console the j2anel, 2robe <br />Al2j ggasgr were found to be functioning Per manufacturers <br />SQecificatiQaa. Tank has —I -L211 of water. <br />Date of Next Test: <br />Ser. #16144 <br />