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0 <br />T4nk and Monitor Summary <br />is <br />"60a Pacific Bell <br />GcolParoel TJP.-148 �. <br />Address 72nnl M-Xjj4jQ,, <br />CLLC: S=AICA I <br />Ciry, Rr-64Lh <br />T" # A 0.�z - <br />Cowuy_ n Oct acU in <br />T"- Permit #int nQted—h4--terh <br />Zip <br />Expiration Datc <br />Iospertion Rccord <br />UuOcrgrouad Siorugc Tank <br />TankSizc:_-2_, OOQ Product_dips,.lFuel lcvcl C test?-gq a], -IF, -1-1 Monitor -za : Stick <br />Agency mquiAagCcnificauoa: San <br />Agtuty signature:_Li/A mquir to be on s47 no <br />Required Testing: Tank: no A:'u^-3I ArnwJIy Lines: no Arinu&J AsmwJly <br />Tasting Permit Required )'es x No <br />Test Type;. N/A ---- - -- <br />Test Datc:8 _29-96 <br />Tcst Performed By. Company See below <br />Contact: <br />Phone Nw^zacr <br />TCsICv Bti- iiccetsc # <br />Test ResuJu. Pass' F� ! <br />Remarks: Double wall tank and -1iLF No tact ii3q r_egijred <br />at this time <br />`iooitoriog System <br />Manufacturer: Veeder Root Moder: m1.S-21)0 <br />Api Ronan X76S-A4-5S <br />Agency Requiring Ccrtifica}ion c;a me a �. hn-,7p <br />Agency Signature: N / A Required to be on site? no <br />Required Testing: xx Sorts- Ann uzJ Mutually <br />Testing Permit Required: Yes x No <br />TcstTypc: Annuual monitor certification <br />Tcst Datc: T8 - 2.- 9 6 <br />Test Performed By; Company DIALYSIS COMPANY <br />ConWcl James or Tamara Zimmerman <br />Phone. 800 227-7879 <br />Tested B) Names Zimmerman <br />Test Results: pass Pass / Fail <br />Rcm&rk5: Panal probe and cmnc ygQra -FQj-i j t,, <br />be functioning as per manufactu <br />C eaned the sump. Sight is equip ed with two monitnr.-,_ <br />To be upgraded to a 350 in 1997_ <br />Date of Next Test:. 8-97 <br />Serial. 9553 <br />8-0111 <br />