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. Data hart for Tank System Tigh _ 3ss Test <br /> petro Tete <br /> PLEASE PRINT TANK TESTER <br /> 1. OWNER Property Chevron USA, Inc. , 2 Annabel Lane, suite 200 <br /> Tanks) [ N3"an Ramon, CA 94583 Address <br /> Tony 7iY'°RZ18' (415) Ms-'5000 <br /> Name Address R.Olwartalive Telephone <br /> 2. OPERATOR Name - 103 W. !f Address 1� q <br /> Lnpnon• <br /> 3. REASON FOR State requirement <br /> TEST <br /> (Explain Furry) —'� --- - <br /> 4. WHO REQUESTED _ A.J. (Tony) Arado Engineer Chevron USA 7/21/86 <br /> TEST AND WHEN Ne21' Annabel Lane, suitena200 . , San Ramo x odustagAn11°"°" (415) 838PJ5000 <br /> ---- --- — <br /> Address Telephone <br /> 5. WHO IS PAYING Chevron USA, Inc. A.J. (Tony) Arado Engineer (415) 838-5000 <br /> FOR THIS TESTI `�°'1(ti$ 13i3�1rf0Y'ane, suite°e7U'Olno'"'°°San Ramon, CA T194583 Telephone <br /> seting Address -- city suite zip <br /> Attention of: Order No. Omar Innnni... <br /> Identify by Direction Capacity Brand/Supplier ratle Approx.Age Stnl/Fiberglass <br /> 6. TANK(S) INVOLVED6 dahixi. S4.1',ofi C&LlranC <br /> goo f/ <br /> It <br /> Location Cover Fills Vents Slph...a Pumps <br /> 7. INSTALLATION <br /> DATA <br /> Nom Into.duvswry. Concrete Black Too. Sire.Tinlill mab.Drop Suction.R.mote. <br /> Reit of antic". to Eum.tic. tunes.R.mota Fills Sue.M.nH.. Which links+ M.ke it known <br /> 6. UNDERGROUND Is the water over the tank 7 <br /> WATER Depth to the Water table_ _ Ye. ff Nd <br /> Tanks to be filled In. Date Arranged by <br /> 9. PILE-UP N.m. r.I.pn.n. <br /> ARRANGEMENTS Extra product to"top off"and run TSTT. How and who to provide 7 Consider NO Lead. <br /> Terminal or other contact <br /> for notice or inquiry <br /> company T.I.phon. <br /> 10. CONTRACTOR, O.H. Materials Corp. 1*4 <br /> MECHANICS, 3900_ Industrial Blvd. ' 3 6 "b <br /> any other contractor W. Sacramento, CA 95691 - --�—� <br /> involved <br /> FWRoMENTAL HEALTH <br /> 11. OTHER _ _ ___._____. _..__ ___ ___ PERMIT/SERVICE <br /> INFORMATION <br /> OR REMARKS <br /> Additional information on any items above.Officals or omen to be act when testing is in progress or completed.Visitors or observers present <br /> during test etc. <br /> Testa were made on the above tank systems in accordance with lest procedures prescribed for PP�rO r}p <br /> 12. TEST RESULTS as detailed on attached test charts with results as follows: �r— <br /> Tank Identification Tight Leakage Indicated _ Date Tested <br /> zz b <br /> This Is to certify that these tank systems were tested on the dates)shoZomIX19 <br /> se Indicated as"Tight"It1Bt the criteria astabi ed by <br /> 13. CERTIFICATION the National Fire Protection Asociation Pamphlet 329.er2 8 D-, <br /> Dela lows ea . <br /> -�-- � — nI f sating Contractor oI mp.nv. ev: nun <br /> Se NO OIThey., <br /> xn cans Address <br /> pA(Z L <br />