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CRISP tntt,(^rEsrING <br /> P. 0. Box 30487 <br /> Si0CK10:1, ;A 95213 ..i <br /> (209) 931.1828 rE Q 2 c 1990 LICENSE #92-1248 <br /> LEONARD E. CRISP <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> 0 rESY IiI;PoR'I' <br /> ONNE? OF SI'1'P_—aa )LI L11 <br /> ADDRF.SS16,3!) UYJ71r( �()/ItCI'1'Yc �r ZIP�iSa <br /> OWNER OF TANK(S) L,,4 ')/)LIE- <br /> ADDRESS CITY 7.•Ip <br /> ' s <br /> OPERATOR AT LOCATIUN LA j)t Cfa&k <br /> ADDRESS q / CT Ty G� CALIF. 7,Ip95�t�s, <br /> NAME OF COUNTY_ Qy� ��!) <br /> TANKi1--]—ON PLOT PLAN. AGE OF TANK'VYRS. CAPACITY_4LL00 GALLONS. <br /> DIESEL_, . PREAIIUPi UNLEADED_, UNLEADED—, REGULAR_, <br /> KEROSENE_, O'THER-Lill a Ill <br /> HETALXFIBERGLASS_ VAPOR RECOVERY SYSTEM: YES_NO_L <br /> TYPE OF SYS'T'EM: SUCTION, SUBMERSIBLE_, OTHER )tj,C n) I <br /> MEASURED API SPECIFIC GRAVITY 32 . PRODUCT TEMPERATURE, <br /> API SPECIFIC GRAVITY @60 ' F <br /> COEFFICIENT OF EXPANSION <br /> TANK FILLED - DA'1'R <br /> TANK TES-1 ' <br /> LENGTH OF - DATE , 2-)Q� START / DU FINISH <br /> OF T ES'T� <br /> TANK BOTTOM TO GRADE /LQ" . TANK TOP TO GRADE 411 � . <br /> DIAMF,TERW _. TEST LEVEL ABOVE GRADE_i ". WATER IN TANK. <br /> DEPTH FOR TAKING SAMPLE a" TEMP. PROBE DEPTH <br /> TEST LEVEL TO 'TANK BOTTOM E. GROUNDWATER ABOVE TANK -,-9e) '. <br /> PRODUCT PRESSURE per 1 " IIEIGHT .p,-�i PSI . 4.0ti <br /> "RESULTS OF TEST" <br /> CERTIFIED 'TIGHT: YES NO_ <br /> LEAKRATEPER HOUR : + - (� a <br /> SIGNATURE OF OPERATOR /`�� G NAME L1=pnntcl <br /> fff777111III 6tvsp- <br />