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CRISIS -i ANA TESTING & C0NTRU(-`l-I0N <br />P.O. MIX 3010 T <br />slm.KIIIia, uA n az13 <br />(i 09) 931- 1 ozo <br />rAX (209) 465-3806 <br />l0. <br />INSURED <br />AI_Tid �( <br />l <br />*'I"LST ItLPO Rl,* *` . <br />LICENSE 12#92-1248 <br />} <br />OWNER OF SITE: -- --- 1�.�`._---------------------- LEONARD E. CRISP <br />ADDRESS:WX---- CITY:cU�{?ln 7,11,:.rZ--- <br />OWNER OF TANKS:-_�a__—_____ <br />ADDRESS:._-_._ <br />CITY: <br />----- -, 7 I F': --- - <br />OPERATOR AT LOCATION:_-5-L-4-hj eQ-—_.___-_____-- <br />ADDRESS: <br />CITY: <br />---- ZIP: ------------ <br />COUNTY,'_ (A. _-6w4dol--)-- TANK#: --t -- AGE:GALLONS:_L�1_. <br />llp_ <br />METAL(-) FIBERGLASS( ) SINGLE WALL.F,D(y-) DOUBLE WALLED( ) <br />DIF.SF.L(.�) UNLEADED ( ) PREMIUM UNL. ( ) <br />SUCTIONO) SUBMERSIBLE( ) OVERSPILI. CONTAINER**YFS(4!) NO( ) <br />SHEAR VALVE**YES( ) NOH IN-LINE I.FAK I)F.TFCTOR**YF,S( ) NO(Y) <br />VAPOR RECOVERY SYSTEM**YES( ) NON) IF YES, PHASE I( ) PHASE II( ) <br />TANK FILL DATF.:"Eol <br />5 TIME:-�C� _ <br />TANK TEST DATE:�5 START:-Dft5 _— <br />LENGTH OF TEST:-2.Lis:- <br />TANK BOTTOM TO GRADE.....�I 7 <br />TANK TOP TO GRADE ............ <br />—" <br />_ <br />DIAMETER :............................. <br />TEST LEVEL ABOVE GROUND-0�- <br />-- <br />WATER <br />WATER IN TANK .................... <br />" <br />DEPTH FOR TAKING SAMPLE....-Ia-_" <br />TEMPERATURE PROBE DF.PTH..LQ=-,5_" <br />PEST LEVEL TO TANK BOTTOM ..... <br />GROUND WATER ABOVE TANK ..... <br />PST .................................................... NET TEST PRESSURE ....................... 3 <br />API SPECIFIC GRAVITY ................. J <br />TF.MPF.RATIIRE................................. <br />API SPECIFIC GRAVITY@b 60' F ...... <br />COEFFICIENT OF EXP......................w�r��� <br />L..FAK RATE PER/HR:+t-Q)%,-?-�(/- _- <br />CERTIFIED TIGHT: YFSf�) NO( ) <br />PRODUCT LINE TI -IST: SUCTION( PRESSURE, } <br />LEAK RATE PER/HR: <br />CERTIFIED TIGHT: YESN NO( ) <br />DATE:24 2- Ct3_ SIGNATURE OF TESTER:_z:��--� ~ --- <br />COMMENTS:-..--_ <br />"Fey llem- <br />