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RECEIVE Data Chart for Tank System Tightness Test <br />NOV 8 1989 <br />PLEASE PRINENVIRONMENTAL <br />HEALTH <br />1. <br />OWNER Flow,, <br />lank(a) ❑ <br />q L Ln 1502 41FL-DIO1rADO srocKroN C� <br />None Address RepleeentetM T°Mph <br />Nall, Address Rapmantedvs Tolophor, <br />2. <br />OPERATOR <br />Norco Address Telephone <br />3. <br />REASON FOR <br />TEST <br />(EAPleln Fully) <br />SWIZIPA <br />S,4 �! <br />4. <br />WHO REQUESTED <br />TEST AND WHEN <br />E CDM s;rocx <br />Addrow Tslaphp, <br />5. <br />TANK INVOLVED <br />IA, addltlonel IInas <br />for manitolded tank! <br />dentin, by DlrMlen cap city BnneBuppxar O da Approx. Ape .SteNlFib"m <br />6. <br />INSTALLATION <br />DATA <br />L«etlon C.,rnl! (—� 4/°1 Z u 51p1,�— aampe VEDJEY-KE <br />PQIUE 5-473 IL�E YZp�&Nv- <br />wnh Inside drlvewey. Concrete. Black Top. Slue, TiNlll make, Drop Suction. Remote, <br />Reer M llatlon, Nc. Earn. ata lube!, Retool. nil. 5¢e. Mrmfoldad Nmkh tenksl Make II known <br />7. <br />UNDERGROUNDz <br />WATER <br />f 1° no water. the tank! <br />Do" to Me Water table I T ❑ y. ❑ w <br />8. <br />FILL -UP <br />ARRANGEMENTS <br />Tank. to be Piled he ole° Amanpsd by <br />Nemo TMephwte <br />Eat- product ft'Up oM and an tank 1Mw. k,ow and wr, to proddel Consider ND LMd. <br />Tercd1c or other cont.-. U W c A L si'o c9kro N <br />foraIral r Inquiry ___ <br />CP1nPony Name TolyRma <br />9. <br />CONTRACTOR, <br />MECHANICS, <br />any Witter contractor <br />Involved <br />10. <br />OTHER <br />M47 -INFORMATION <br />OR REMARKS <br />Uy. S .5 -rig - <br />AddaisnN letwmenon on any Item. abovee111CIA19 or otnera to no entla d when teannq b In prop. or eompMed. Nsllon or onapan peak, dune M. at0. <br />11. <br />TEST RESULTS <br />Teeb wen made on the above tank systema In accordance with teal procedures prvow:i bed for <br />r detelled on attached toot dmb with raeutte n follows <br />Tank IdentlRran. mgm Leek°pe Indicated Dole Tested <br />12. SENSOR <br />CERTIFICATION <br />qi o <br />s.,IN w..1 Therm,, <br />13. This Is to certify that asses tank systema were tested on the date($) shown. Those Indicated e, hr mea, the crlterle aNablisMd by the <br />NettonN Fire Protection Auoclallon Pamphlet 32A <br />r� ,! recnnlclem — <br />orn oBASShp.ny. By hl.e <br />Don,"v,lp1, p California Lic. <br />W_.__..__ _ .._ — <br />(916) 967-7424 <br />Csdlacatlpn a MM27 <br />T <br />