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LICENSE #92-1248 <br />CRISvP <br />LEONARD E. CRISP <br />P.O. BOX 30487 � �"' TINGStockton, California 6/ul/0 <br />(209) 931-1828 <br />rLST RLPORr <br />OWNER OF SITE <br />ADDRESS t,,, a r•_,5,�y�; CITY <br />OW��-� ___S T A T E�.P Z I P OWNER OF TANICS�Z.%� � S�b��- �•�' <br />ADDRESS�����.4�� CITY � <br />1 (z STATE ZIP 1 3 7�C <br />OPERATOR AT LOCATION Gc7 Ii15; &R �J�) <br />ADDRESS 57C/ (>�Lt �J CITY_ {l STATE <br />NAME OF COUNTY. � <br />NAME �l <br />.. : [fir PLOT AN. AGE OF 7ANI< (9 <br />DESCRIPTION OF TANK: <br />CAPACITY ` &UV ,DIAMETER 9` <br />METAL FIBERGLASS <br />TYPE OF SYSTEM: SUCTION : SUBMERSIBLE <br />VAPOR RECOVERY SYSTEM? TYPEL <br />X •OTHER <br />a <br />PRODUCT BEING TESTED MEASURED (,RAVITY_ <br />API SPECIEIC GRAVITY (0 60°F *')• <br />,t�� PRODUCT TEMP.. 0 COE G"mss%% <br />STORAGE L • _ DATE - TIME <br />TESTED - DATE ( -/`�-� y , START Q(n(SZ , FINISH O"7 � • <br />LENGTH OF TEST a mu <br />MEASURED WATER IN TANK} <br />lir_IGllr OF LIQUID LEVEL <br />DEPTH OF GROUND WATER-�--__. PSI AT TANK BOTTOM <br />RESULTS OF TEST: <br />CERTIFIED TIGHT? - YES_X <br />LEAK RATE PER HOUR: + or <br />-' NO IF X10 EXPLAIN IN REMARKS. <br />REMARKS BY OPERATOR <br />NAME OF OPERATORbei <br />SIGNATURE OF OPERATOR <br />DATE <br />I <br />