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g <br /> Crisp <br /> Tank Testing & Construction Company <br /> T <br /> Phone (209) 931-1828 Urnneed <br /> ► ' <br /> Post Office Box 30487 Inm sled <br /> Sfocidon,California 95213 <br /> **TEST REPORT** <br /> OWNER OF SITE -- <br /> ADDRESS: S y w G ►' 6h �lir� Z CITY: , (_(�. 'LIP�)�f <br /> OWNER OF TANKS: <br /> ADDRESS: CITY: ZIP : <br /> OPERATOR AT LOCATION: � I• !'J J ) ) 1 (.11- <br /> J - --- <br /> ADDRESS s S[9 /7l r S is j(.7V CITY: ► ZIP : <br /> COUNTY: C (a)1 A0a TANK #: 0)) C_ AGE: GALLONS:' ' _ <br /> y, ;• r, <br /> METAL( 4) FIBERGLASS( ) SINGLE WALLED(�l) DOUBLE, WALLEW ) <br /> DIESEL( ) UNLEADED( ) PREMIUM UNLEADED( ) ( ) <br /> WASTE OIL( ) KEROSENE( ) AVIATION GAS( ) JET FUEL( ) WATER( ) <br /> SUCTION( ) 8UBMERSIBLE(?K) OVERSPILL CONTAINER--YES(Y) NO( ) <br /> SHEARVVALVE--YES(x) NO( ) IN—LINE LEAK DETECTOR--YES(x) NO( ) <br /> VAPOR RECOVERY SYSTEM--YES(>O NO( ) *IF YES , PHASE 1 (><) PHASE 7. (\<) <br /> TANK FILL DATE: • O IME:_I _00 <br /> TANK TEST DATE: ) START: 0 END LENGTH OF TEST: • <br /> TANK BOTTOM TO GRADE. . . .-JH TEST LEVEL TO TANK BOTTOM---.,/ , ? <br /> TANK TOP TO GRADE. . . . . . . �J GROUND WATER ABOVE TANK . . <br /> DIAMETER: . . . . . . . . . . . . . . . q_� PSI . . . . . . . . . . . . . . . . . . . . . . <br /> TEST LEVEL ABOVE GROUND._1 a NET TEST PRESSURE. . . . . . . . <br /> WATERIN TANK. . . . . . . . . . . API SPEC GRAV . . . . . . . . . . . . �. <br /> DEPTH FOR TAKING SAMPLE. 0 TEMP. . . . . . . . . . . . . . . . . . . . <br /> TEMPERATURE PROBE DEPTH. 7 API SPEC GRAV C 60 ' F . . . . <br /> COEFICIENT OF EXP. . . . . . . . , r ' <br />! CERTIFIED TIGHT--YES(-/) NO( ) LEAK RATE PER/11R: + <br /> PRODUCT LINE TEST--PASS(X) FAIL( ) SUCTION( ) PRESSURE(X) <br /> CERTIFIED TIGHT--YES04) NO( ) LEAK RATE PER/11R: + = /- <br /> COMMENTS a h1T c1i (' �) ; ) a (-'1 1 <br /> L <br /> DATE:�— 93 SIGNATURE OF TESTER-/ <br /> REV• 3/92 <br />