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Crisp Tank -testing & Construcnon Company <br />Phone (209) 931-1828 .., Licensed <br />Post Office Box 30487 C g z: r' Insured <br />Stockton, California 95213 F E 8 U 3 199JONSE #92-1248 <br />ENVIRONMENTAL r c_A4LE Cw <br />*TEST REPOWMIT/SERVICES <br />OWNER OF SITE: CAk*/LC1kQ)A f -11G11(,0/\ j' <br />ADDRESS: �� b 5/ ��. GCIi n.C/,,/���, k� CITY: lb(! S� A zIP�7 - <br />OWNER OF TANK(S) :"" Co Ak) i'GR_l�1/A J; 16i -I0 m3 Pfi /look. <br />ADDRESS: �2i.� W 'kAtD/.�nl'j�JF^Q�?ITY: %�Y1�S"/ (, ZIP ,��J. <br />OPERATOR AT LOCATION: '(p��Ak1lykI ) J111 <br />ADDRESS: 3b\\�/ l�. �/vll���s(/i��C- K�ITY: / �1��}� C�f- ZIPq_�37 <br />COUNTY: SA;`) `iNFlTANK #:_CjL)L,• AGE: YRS. QW GALS. <br />METAL:_ FIBERGLASS :. SINGLE WALLED:_✓ DOUBLE WALLED:_ <br />DIESEL:_ UNLEADED: V-' PREMIUM UNLEADED:_. REGULAR LEADED:_ <br />WASTE OIL: _ KEROSENE: _ AVIATION GAS: JET FUEL:_ WATER:_ <br />SUCTION:— _ SUBMERSIBLE: Lam, OVERSPILL CONTAINER --YES NO <br />SHEAR VALVE --YES :NO_ IN LINE LEAK DETECTOR --YES V7N0 <br />VAPOR RECOVERY SYSTEM --YES �'JNO_ IF YES, PHASE 1:LZ PHASE 2:(-< <br />TANK FILLED --DATE: TIME: <br />TANK TESTED- -DATE:.�y START 1j, .�. FINISH: /7:/,) <br />LENGTH OF TEST: �_HOURS. `CJ MINS. <br />TANK BOTTOM TO GRADE '. TANK TOP TO GRADE:". DIAMETER:". <br />TEST LEVEL ABOVE GRADEZa". WATER IN TANK -Q-_". <br />DEPTH FOR TAKING SAMPLE TEMPERATURE PROBE DEPTH:". <br />TEST LEVEL TO TANK BOTTOM: k O"./ GROUND WATER ABOVE TANK: ". <br />PSI: .0 (c NET,TEST PRESSURE:. & * [API SPEC. GRAV.: .rj* TEMP::] <br />/ COEFFICIEMm of <br />CERTIFIED TIGHT--YES_NO_ [API SPEC. GRAV. C 60' F:* EXP:.dp�)(,"�g'p <br />LEAK RATE PER HOUR: + * - . Ur2'6CI * <br />DATE OF REPORT: — - o SIGNATURE OF TESTr: <br />(REV. 4/91) / <br />