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<br />ABOVEGROUND STORAGE TANK TIGHTNESS TESTING <br /> <br />Facility Name: 3 B’s Auto Plaza Name (Company): <br />CGRS, Inc. <br />Address: 14749 Pennant Drive Company’s Address: 5444 Dry Creek Road <br />City: Lodi State: CA Zip: 95242 City: Sacramento State: CA Zip: 95838 <br />Contact Name: Joseph Hernandez Phone # (800) 511-9300 Contact Name: Garrett Warren Phone # (916) 991-1100 <br />Contact Email: jhernandez@advancedgeo.biz Contact Email: mredman@cgrs.com <br />TEST RESULTS <br /> <br />Tank Information <br /> Tank # #2 <br />New / Used Tank USED <br />Construction (UL142 / SwRI / UL2080 / UL2085) UL142 <br />Tank Wall Type (Single / Double) Double Wall <br />Total Capacity (gals) 500 gallons <br />Compartmentalized Tank (Yes / No) No <br />Number of Compartments 1 <br />Tank Manufacturer Containment <br /> Solutions <br /> <br />Tank Model (Envirovault, F921, etc.) Lube Cube <br />Test Results <br />Note: Choices for Test Method Used are – (P) pressure, (V) vacuum, (H) hydrostatic <br />P r i m a r y <br />Test Method Used (P / V / H) <br />Test Start Time <br />Initial Reading <br />Test End Time <br />Final Reading <br />Change In Readings <br />Result (Pass / Fail) <br />S e c o n d a r y <br />Test Method Used (P / V / H) Vacuum <br />Test Start Time 12:30pm <br />Initial Reading -4.0 inHg <br />Test End Time 1:30pm <br />Final Reading -4.0 inHg <br />Change In Readings None <br />Result (Pass / Fail) Pass <br />CUPA inspector present during testing Yes X No <br />Inspector Name: Inspector Signature: Date: / /_ <br />I certify under penalty of law that the information provided here and in supporting documents is true, accurate, and complete. <br />Note: When an CUPA Inspector is not present during testing, this form must be signed by the Tester AND Owner before submitting to CUPA. <br />Tester Name: _ Garrett Warren Tester Signature: Date: 01 / 26 / 2022 <br />Owner Name: Owner Signature: Date: / / <br /> <br />Submit to CUPA within 30 days of completion.