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Crisp' Tank Ttfing & Cons tru, iohl-'Com an <br />Phone (209) 931-1828 <br />Post Office Box 30487 <br />Stocidon, California 95213 <br />OWNER OF sSSI�TE: <br />ADDRESS :.c/ <br />OWNER OF TANKS: Q -- <br />ADDRESS: <br />OPERATOR AT LOCAATION: <br />ADDRESS: <br />COUNTY,t—@_/� <br />**TEST REPORT** <br />LICENSE #924248 <br />LEONARD E. CRISP <br />Licensed <br />Insured <br />MWWF A I�! <br />CITY• / -f-ZIP: <br />CITY: ! ZIP:� <br />TANK #: ,/ . AGE: GALLONS : 6,p�l?)(' <br />METAL 'FIBERGLASS( FIBERGLASS( ) SINGLE <br />WALLED(;t) DOUBLE WALLED( ) <br />DIESEL( ) UNLEADED PREMIUM <br />UNLEADED( ) REGULAR LEADED( ) <br />WASTE OIL( ) KEROSENE( ) AVIATION <br />GAS( ) JET FUEL( ) WATER( ) <br />SUCTION( ) SUBMERSIBLE(XI OVERSPILL <br />CONTAINER--YES(X) NO( ) <br />SHEAR VALVE--YES(x) NO( ) IN-LINE <br />LEAK DETECTOR --YES( NO( ) <br />VAPOR RECOVERY SYSTEM --YES NO( ) <br />*IF YES, PHASE 1,e) PHASE 2,�r) <br />TANK FILL DATE: - - � TIME: <br />_ <br />TANK TEST DATE: .2- - ,Z START: END: LENGTH OF TEST .-e <br />TANK BOTTOM TO GRADE.... � �, , <br />TEST LEVEL TO TANK BOTTOM /�3 <br />TANK TOP TO GRADE..... .. <br />GROUND WATEP. ABOVE TANK. .� <br />DIAMETER ................. <br />PSI..................... onzz <br />TEST LEVEL ABOVE GROUND. __/.,5-._ <br />�. <br />NET TEST PRESSURE ........'If <br />WATER IN TANK.......... • <br />API SPEC GRAV. � <br />.......... <br />DEPTH FOR TAKING SAMPLE. /D�.S + <br />TEMP ..................... <br />TEMPERATURE PROBE DEPTH. �% ,• <br />API SPEC GRAV @ 60' F.... _ <br />COEFICIENT OF EXP........,(���% <br />CERTIFIED TIGHT--YESX) NO( ) <br />LEAK RATE PER/HR:+/-Q,7 <br />PRODUCT LINE TEST --PASS( ) FAIL( ) <br />SUCTION( ) PRESSURE( ) <br />CERTIFIED TIGHT --YES( ) NO( ) <br />LEAK RATE PER/HR:+ /- <br />/' o <br />DAT.E:_'� �- �i� SIGNATURE OF TESTE <br />0 <br />COMMENTS: <br />REV 3/92 <br />