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Data M_if for Tank System Tightnr Test <br /> aUMICKIS PI2flCI3 M 7= 72S IM <br /> 1451 Oakhurst Way, Sacramento, CA 95822 <br /> PLEASE PRINT (916) 927-8155 * (800)_34.6-4839 <br /> seaeosesse <br /> pN.m. k o n1. OWNER vrorq ❑ i J Tw <br /> Tank(s) R.prewn...s TaNpmns <br /> Nam. AMrN <br /> C <br /> 2. OPERATOR Name <br /> 3. REASON FOR RPGTIT ATION GOVERNINCE S <br /> TEST <br /> (Explain Fully) ADMINISTRATIVE <br /> 4. WHO REQUESTED Nam. Tocompany«.Nebeon Dn. <br /> TEST AND WHEN <br /> Tebok«w <br /> •new. <br /> 5. WHO IS PAYING OWNER <br /> TWPn^^ <br /> company.Agency or InCnidual venon AUN«iilnp title <br /> FOR THIS TESTI <br /> eNbrq Add.... uN 5uu 2iP <br /> .n.«ron or dee.Ne. Omer rnn.ucriem <br /> Identity by Direction Capacity Brats/Supplier GIs& AW...Ape Stast/Frberplass <br /> 6. TANK(S) INVOLVED 01 00 0 <br /> Location cover Filo vents 50 has 'WbU P1u`m/ps', <br /> 7. INSTALLATION Q� /�� n P. <br /> DATA LU`C +�nG2�z1 C ° -z o — 5�`Y10r1 <br /> Nene banes ddvewn. CP.CW..Stack Top. Sm,Thione mak..Drop Seceon,Maness,nen of nngn,rte Eanh.stc a Ilen <br /> tupe R1b Sin.Msalowse which.."I MN.a brown <br /> Is the water over the rank) <br /> 8. UNDERGROUND Y. lad <br /> WATER Depth to IM Water table <br /> Tanks to-M filled_nr. Dau Arra Wed by— Name ieuon«w <br /> S. FILL-UP <br /> ARRANGEMENTS Extra product to"'top on"and n,n TSTT. Now and who tp provlda7 Consoler NO Lead. <br /> Terminal«other contact <br /> f«not..d mq.dy Cpmoanr MnM TMgMrw <br /> 10. CONTRACTOR. -- ----- - -- - •—_..._._ --- <br /> MECHANICS. <br /> 'any other contract« <br /> mvoHed <br /> 11. OTHER — <br /> INFORMATION <br /> OR REMARKS <br /> Atldnronal mr«maoon on any gems aeova.011iciab«o<Me to be adwsM wMn testmp n m progross« completed.Vinton«oMwvcn Pasant <br /> durmp test ata <br /> Tests sen made on its,above tank systems in ateordanpe with test procedures prescribed for Pf4m r—h- <br /> 12. TEST RESULTS as detailed on snached test charts with results es fallors: <br /> Tank Identdmaoon TIM Leakage Irdwatad Data Tested <br /> a 5 ` 7__ — <br /> This is to certify that these bank systems Wats Leaked on the dates)ShIlai ,Those iridic ted as••Tight••meet to cattarfeoaltabil d tM <br /> 13. CERTIFICATION the National Fire Protection Asociath n PWV4~129- <br /> 9-27-89 William Campbell CHAMPION ' S PRECISION TANK TESTING <br /> p.0 T—. ., pn uaoi c,compare.. 8.. Sronem.. <br /> 1451 Oakhurst Way - Sarrama to [ a-1 <br /> .ppufa <br /> Sent Na aTMnnY Tecmm�,ns <br />