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Data Ch,.t for Tank System Tightn_,s Test <br /> PLEASE PRINT CHAMPION':S57RECTSION TANK <br /> 1. OWNER ►rowny ❑ <br /> Name weellg RIll .Or..nbh•. Tx.YneM <br /> Tank(') ❑ Attn: J1ID <br /> Name wear•.. R.p4unUtw. Tx.how. <br /> 2. OPERATOR �dT 2S RCA CJI I <br /> x.me wears. <br /> TN•MOM <br /> 3. REASON FOR REGIJTATION GOVERNING UNDERGROUND STORAGE OF HAZARDOUS SUBSTANCES <br /> TEST SUBCHAPTER 16 OF CHEATER 3 OF TITLE 23 OF THE CALIFORNIA ADMINISTRATIVE CODE <br /> (E.pl.in Fully) <br /> 1. WHO REQUESTED OWNER <br /> TEST AND WHEN serve Title Comw.,erAfild.l n pass <br /> Admu TafewoM <br /> 5. WHO IS PAYING <br /> FOR THIS TESTI Co .we.ner or mm.ieo. P.,..,,Amno,unw, iia. <br /> lahM Asia... City Stn. 2q <br /> ARer.Ret.of: Oq.No. Otnu mnruu,on. <br /> Identify by Direction capacity P v Rural/Supplier Gods Apwm.Aper I Steel/fiberpl.µ <br /> 6. TANK(S) INVOLVED K)- V=� ) 000 <br /> Location Cover Fills Vents Sghon.s Pumps <br /> 7 DATA INSTALLATION �rOleD F Z�J <br /> S-ri�eC C1iy9r+C�ir= c! " Z!" <br /> NorR.insW.srivepr. Concnre.suck Toe. Size.Ts•fia gab.Drop <br /> Rur Ol.boon,.1. Emn..1. WU..Ramel.F,IN An,M.nddd.e Which un..t Male if know. <br /> 8. UNDERGROUND I.the wet.over the lank r <br /> WATER Depth W In*Witter table <br /> � ^. ❑ yes ElNo <br /> la rt^y10-1-40Tank$ be IJled 1_11 ha. 11ss4Q Date Arranged by Wr1TW <br /> 9. PILE-UP ham. THepneM <br /> ARRANGEMENTS E.b,product to-top off'and run TSTT. How and who to p ov de 7 Consider NO Lead. <br /> im kill <br /> Terminal or other contact t )hle <br /> for notice or anclu,ry 1/ <br /> Como... ..m. TV.,.... <br /> 10. CONTRACTOR. <br /> MECHANICS. 1) <br /> any other contractor <br /> involved <br /> 4 n <br /> 11. OTHER T <br /> INFORMATION <br /> OR REMARKS <br /> Additional information on any rums above Officials or others to be advised when testing is.n progress or completed.Visitors o,observed p,sent <br /> during test etc. - <br /> Tests were made on the above tank systems in accordance with test procedures prescribed for PETRO T'ITE <br /> 12. TEST RESULTS as detailed on anached test Chats with results as follows: <br /> ink Identification Tight Leakage lnd,c.IVI l Dale Tested <br /> WM <br /> i <br /> Thls Is to certify that the"tank systems were tested can the cl an"&Those Indicated as"Tight'meet the etteris established by <br /> 13. CERTIFICATION fn.Nelbnal Fire protection Asoci.hon Pamphlet 329. <br /> 10-1-90 CHAMPION'S PRECISION TANK TESTING <br /> OV. <br /> Q2-137.!.1 2308 HARVARII•• 4e;^• E1MAT0; CAS:°Vs81s <br /> Swot xo of TM.m,x T.r .. ,. _ _ , r .nn.... <br />