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. !• f <br /> ;Crisp Tank Testing & Construction Company <br /> Phone (209)931.1828 Licensed <br /> Po=t Office Box 30467 Insured <br /> Slocidon,California 95213 <br /> II -- **TEST REPORT** <br /> OWNER OF SITES > I� d 11 ifs ���UCi nI � Y' - <br /> ADDRESS: 7 y u/ G rah >l�I I1 CITY: .y- 7LV , iZI '1 ', s <br /> OWNER OF TANKS: <br /> ADDRESS: CITY: / ZIP <br /> OPERATOR AT LOCATION: ✓•a 11 Ll r e-O ! 1 11 0 Y y --. -- <br /> ADDRESS: Sc? /1t P LatfC� CITY: ► ZIP: _- <br /> COUNTY: TANK #: 0)) C_ AGE: GALLONS: . <br /> METAL( 4) FIBERGLASS( ) SINGLE WALLED(yi) DOUBLE WALLET)( ) <br /> DIESEL( ) UNLEADED(-/) PREMIUM UNLEADED( ) -A ) <br /> WASTE OIL( ) KEROSENE( ) AVIATION GAS( ) JET FUEL( ) WATER ( ) <br /> SUCTION( ) SUBMERSIBLE(K) OVERSPILL CONTAINER--YES(v) NO( ) <br /> SHEARVVALVE--YES( -) NO( ) IN-LINE LEAK DETECTOR--YES(x) NO( ) <br /> VAPOR RECOVERY SYSTEM--YES(X) NO( ) *IF YES, PHASE 1 (`<•) P11ASE <br /> TANK FILL DATE:T v' TIME: U G <br /> TANK TEST DATE:?-o?/- 7START: D END: t> f LENGTH OF TEST: ) <br /> `• <br /> TANK BOTTOM TO GRADE. . . . l `�8 TEST LEVEL TO TANK BOTTOM; , 1 <br /> TANK TOP TO GRADE. GROUND WATER ABOVE TANK . - <br /> DIAMETER. . . . . . . . . . . . . . . . �f_� PSI . . . . . . . . . . . . . . . . . . . . .! <br /> TEST LEVEL ABOVE GROUND. NET TEST PRESSURE. . . . . . .. . <br /> i- <br /> WATER IN TANK. . . . . . . . . . . API SPEC GRAY . . . . . . . . . . . . <br /> DEPTH FOR TAKING SAMPLE. /0 / TEMP . . . . . . . . . . . . . . . . . . . . <br /> TEMPERATURE PROBE DEPTH. / API SPEC GRAV C 60 ' F. . . . _ <br /> • COEFICIENT OF EXP. . . . . . . . , <br /> CERTIFIED TIGHT--YES(`/ ) NO( ) LEAK RATE PER/11R: + <br /> PRODUOT LINE TEST--PASS(X) FAIL( ) SUCTION( ) PRESSURE(X) <br /> CERTIFIED TIGHT--YES(>C) NO( ) LEAK RATE PER/11R:+ <br /> COMMENTS:tan jT b di s r 0 j 1 <br /> DATE:_r)- pSIGNATURE OF TESTER )1 rt <br /> REV- 3/92 <br />