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Crisp Tank Telti & C4nstruati'6n Company <br /> Phone (209) 931-1828 un Va:. a1 ..._._.., <br /> Post Office Box 30487 MAR 17 1993 LICENSE #92-1248 I�Insu�ed <br /> Sfocidon, California 95213 g LEONARD E. CRISP <br /> CNV►RbNME�JTAL HEALTH <br /> *TM If V�WIfta <br /> OWNER OF SITE: 7� 1 1 r a,� <br /> ADDRESS: < < ITY: ,K 1?.!t-fF' 712:; ZIP <br /> OWNER OF TANKS: r <br /> ADDRESS: CITY : ZIP: <br /> OPERATOR AT LOCATION: - ._ aym'e <br /> ADDRESS: CITY: ZIP: <br /> COUNTY: i TANK _AGE: GALLONS: <br /> METAL(' FIBERGLASS( ) SINGLE WALLEDOO DOUBLE WALLED( ) <br /> DIESEL( ) UNLEADED( ) PREMIUM UNLEADED( ) ( ) <br /> WASTE OIL( () KEROSENE( ) AVIATION GAS( ) JET FUEL( ) WATER( ) <br /> SUCTION( ) SUBMERSIBLE( ) OVERSPILL CONTAINER--YF.S( ) NO( ) <br /> SHEAR`.'VALVE--YES( ) NO( ) IN-LINE LEAK DETECTOR--YES( ) NO(\-) <br /> VAPOR RECOVERY SYSTEM--YES( ) No(;k ) *IF YES , PHASE 1 ( ) PHASE 2( ) <br /> TANK FILL DATE: TIME: _ <br /> TANK TEST DATE:c,2 START- END:..-//-5C' LENGTH OF TEST: <br /> TANK BOTTOM TO GRADE. . . . _ TEST LEVEL TO TANK BOTTOM ''/ ) <br /> TANK TOP TO GRADE. . . . . . . j GROUND WATER, ABOVE TANK . . 'E} <br /> DIAMETER. . . . . . . . . . . . . . . . r` g PSI . . . . . . . . . . . . . . . . . . . . . . . ��1 <br /> TEST LEVEL ABOVE GROUND. NET TEST PRESSURE . . . . . . . <br /> WATER IN TANK . . . . . . . . . . . API SPEC GRAV . . . . . . . . . . . . <br /> DEPTH FOR TAKING SAMPLE . ]'EMT 1�f > r , . <br /> '�qq . . . . . . . . . . . . . . . . . .� <br /> TEMPERATURE PROBE DEPTH. 7 API SPEC GRAV @ 60 ' F. . . . <br /> COEFICIENT OF EXP. . . . . . . . , UQ©41579 <br /> CERTIFIED TIGHT--YES( NO( ) LEAK RATE PER/HR:+ <br /> PRODUCT LINE TEST--PASS( ) FAIL( ) SUCTION( ) PRESSURE( ) <br /> CERTIFIED TIGHT--YES( ) NO( ) LEAK RATE PER/HR: + - <br /> COMMENTS: <br /> DATESIGNATURE OF TEST ; d <br /> REV 3/92 <br /> f <br />