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OIL EQUIPMENT SERVICE STATE LICENSE No.323417 <br /> CLASSIFICATION: A-EAZ.,C61D40 <br /> Division Of Keith A. Tallia, Inc. STATE ENVIRONMENTAL ASSESSOR No.01781 <br /> Telephone: (209)754.1608 <br /> Fax: (209)7545726 <br /> Post Office Box 950 <br /> 750 Industrial Way <br /> SAN ANDREAS, CALIFORNIA 95249 <br /> HORNER EZY-CHECK CERTIFICATION <br /> Owners Property Tanks(s) Pp, <br /> Company (!kAr(. ;{. c.T-a,J ?Fc 4Y Phone_(_ <br /> Address --72( N LZN O J --17-, <br /> City J7ack-,-t'j State EA• Zip <br /> Name & Location of Company <br /> Company S.4 Phone_L� <br /> Address <br /> City State Zip <br /> NOTICE TO OWNER(5)I A COPY OF THIS TEST RESULT HAS BEEN FILED WITH THE PROPER REGULATORY AGENCY, <br /> WHICH IS REASON FOR TESTING <br /> 'NOTICE`IT IS THE RESPONSIBILITY OF THE OWNER(S)TO CONTACT THE LOCAL ENV. HEALTH DEPT.,IN <br /> HIS/HER AREA OF ANY TANK FAILURES WITH(24)HOURS. <br /> Who requested When? <br /> Identify by LD Product Capacity Apx. Age Steel Fiberglass Brand/Supplier <br /> Tanks to be filled Date: Time: <br /> Distributor Extra Product to top off <br /> Comments <br /> REPRESENTATNE(5)OR OWNER(S)YA.L BE NOTIFIED w-EN THE TEST HAS BEEN COMPLETED AND ONE OFFICIAL MUST BE PRESENT DURING <br /> THE TESTING. ALL TESTS MADE ON THE TANK(S)SYSTEMS ARE VALID THE HORNER-EZY CHEK LEAK DETECTION PROCEOURES. <br /> TI CERTIFICATION SHOWS THE CRITERIA ESTABLISHED BY THE NATIONAL FRE ASSOC.(Pr. WM LET 3291. <br /> Test Results Include Tank(s) 13?tine(s) apor Recovery System ❑ Vent Line(s)0� <br /> Tank Tight Tight Leak/Per Hr. Leak/Per Hr. Date Tested <br /> ID# Tank <br /> er� Lines Ind. Tank Detected Line <br /> Y t N 0 Y 0 N <br /> Y N O Y N O <br /> Y 0 N Y O N 0 <br /> Y N 0 Y 0 N <br /> Technician: _ /.c �c ����� Certification #: Qd —i}w <br />