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Crisp Tank Testing & Construction Company <br /> Phone <br /> ll <br /> PoslOfflce Box 30407 I ✓;+�L^' ��� Insured <br /> Slocldon, California 95213 ,1,, UCINSE #92-1248 <br /> JAN 14 1991 LEONARD E. CRISP <br /> *TEST REPORT* <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> (� DATE: <br /> OWNER OF SITE: 1 )(�� ���� <br /> ADDRESS:JL�Q 0Y, Ion] C Ir`' k . CITY : AZIP: M1 . <br /> OWNER OF TANK( S): _11r) (A 1f <br /> ADDRESS43a. 0KARd 1 CII 1 CITY : IC /1C. <br /> OPERATOR AT LOCATION: I 1 I' Dije L IA LIC.(1 <br /> ADDRESS:-: l7CITY : C_ r) (11AZIP: 6- <br /> NAME OF COUNTY : I1 �GLCf1 ( ((1 AGE OF�TTANK: <br /> TANK#::. CAPACITY : , boo GALLONS . METAL: /� FIBERGLASS: <br /> SINGLE WALLED:X- DOUBLE WALLED: DIESEL: PREM. UNLEADED: <br /> UNLEADED: REGULAR LEADED: KEROSENE : WASTE OIL:: AVGAS:_ <br /> VAPOR RECOVERY--YES N0:. IF YES, PHASE 1 : PHASE 2 : <br /> SYSTEM TYPE--SUCTION: SUBMERSIBLE:_. INLINE LEAK DETECTOR--YES NOK <br /> SHEAR VALVE--YES NO_)(_. OVERSPILL CONTAINER--YES:NO <br /> TANK FILLED--DATE: .. <br /> /I(- /'�� ,/ TIME: <br /> TANK TESTED--DATE :-I. / , START: � `f FINISH: <br /> LEGNTH OF TEST: HOURS . _MINS. <br /> TANK BOTTOM TO GRADE :-ILL" , TANK TOP TO GRADE::L DIAMETER : <br /> TEST LEVEL ABOVE GRADE :s WATER IN TANK :: <br /> DEPTH FOR TAKING SAMPLE : , TEMPERATURE PROBE DEPTH:Aa.. . <br /> TEST LEVEL TO TANK BOTTOM " . GROUND WATER ABOVE TANK: <br /> PSI : NET TEST PRESSURE: OIC <br /> **RESULTS OF TEST** <br /> CERTIFIED TIGHT--YES:NO_ <br /> LEAK RATE PER HOUR: + _ N)6D- <br /> 1 <br /> SIGNATURE OF TESTER : (�(�U � <br />