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Champion P 0. Box 13059 <br /> iPrecision Tank Testing S�amento, CA 958133059 <br /> LJtansa No. 73848 CA BOO-660.9443 <br /> NEV 800-949-9443 <br /> (916) 927.1557 <br /> Fax: (916) 927-7345 <br /> HORNER EZY-CHECK CERTIFICATION <br /> Owners Property Tanks(s) <br /> Company,, ,/i 1 r r Phone_) <br /> Address /yaS G ✓'r sT <br /> City Hca/� State f'.A Zip <br /> Name& Location of Company <br /> Company SA,.., Phone_L_ ) <br /> Address <br /> City State Zip <br /> NOTICE TO OWNER(S)I A COPY OF THIS TEST RESULT HAS BEEN FILED WITH THE PROPER REGULATORY AGENCY, <br /> WHICH IS REASON FOR TESTING <br /> 'NOTICE'IT 5 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 I.D Product Capacity Apx Age Steel Fiberglass Brand/Supplier <br /> Tanks to be filled Date y— 2- /— 9 Time: J 6 a <br /> Distributor Extra Product to too off S T / <br /> Comments <br /> REPRESENTATIVE(S)CR OVVNER(S)Y&L BE NOTFIED VMEN THE TEST HAS BEEN COMPLETED ANO ONE OFFIC AL.MUST BE PRESENT OLM4G <br /> THE TESTING. ALL TESTS MADE ON THE TANK(S)SYSTEMS ARE VALID THE HORNER-EZY CHEK LEAK DETECTION PROCEDLR2ES. <br /> THLs CERTIFICATION Slaws THE CRITERIA ESTABLISHED BYTHE NATIONAL FIRE Assoc.(PIAM PLfT 329). <br /> Test Results Include Tank s) trin s [�Va or RecoverySystem C�7—tlent Line(s) � <br /> Tank Tight Tight Leak/Per Hr. Leak/Per Hr. Date Tested <br /> ID# Tank Lines Ind. Tank Detected Line <br /> Y tf'R ❑ Y 5-IN ❑ — asT wi -t <br /> ores 6C <br /> Z Y WIN ❑ Y BSN ❑ a 9f?9s �, �� .� ,r <br /> 3 Ym-/N ❑ Y@ 'N ❑ S <br /> Y ❑ N ❑ Y ❑ N ❑ <br /> Technician: —,P4 / ,�,,�,� Certification <br />