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Until trua i for laft Jystem i igniness lest <br />p%tro Tit% <br />PLEASE PRINT <br />TANK TESTER <br />I. OWNER PrpPerty A co _P, O, Box 5811 San Mateo, Cati,s. 94402 Ron Mitt 1-800-421-7457 <br />all <br />W me — -- <br />Tank(s) -- -- Addle - <br />Telephone <br />Addle" <br />Reprewnau•e Telrph — <br />2. OPERATOR <br />ARCO #4932, 16 E. Harding Way/N. Center, CA <br />DM <br />--Stockton, <br />3. REASON FOR <br />To check �,ohightnuse <br />Telephone <br />TEST <br />— -- - - -- --- <br />- --_ _----- <br />(Explain Fully) <br />4. WHO REQUESTED <br />Ron M.c ee6 Aheo <br />TEST AND WHEN <br />"'T.O. Box 5811 San Mateo, N1eCaeisohL 94402 CompanyerAni " <br />, a <br />dame, <br />AOCress <br />Ahco <br />Telephone <br />5. WHO IS PAYING <br />Ron M,ifu <br />FOR THIS TEST? <br />T� <br />f"&ny'15ff '8"u"' San Mateo, ZeiiQ("" yjii,°ia 94402 <br />bQme <br />Telephone <br />Bllline Addreas <br />City SYN <br />Zip <br />Attenefon of <br />Order No. OIMr Irratnactiwta <br />6. TANKS INVOLVED <br />Identify by O;reion <br />Est <br />Csc <br />paty <br />/ •Oco <br />Brand ser <br />�u U-1 <br />Grade <br />Su <br />'`�"p• Ago <br />st«vF;bergl.as <br />CX <br />-til e- <br />coo <br />LAK <br />Asf <br />ObC, <br />U <br />D <br />7. INSTALLATION <br />Location Cover / Fills Vents Siphons <br />} <br />Pumps <br />DATA <br />� OC" D <br />S <br />, <br />North Inside driveway, Concrete. Black Top, Size. TiWill make, Glop <br />Rear of sutlon, etc. Earth, etc. tubes, Remote Fills Size, Manifold" Which tanks 7 <br />n. Ramatti. <br />Sucti fl known <br />8. UNDERGROUND <br />WATERJ <br />Is the water over <br />the tank 7 <br />Depth to IM Water cable I T 1:1 Yes <br />Tanks to be Fled A n,. /b-6 - 6 1 <br />9. FILL -UP <br />Date Arranged by k -i , (r- <br />ARRANGEMENTS <br />Name <br />Eters Product to "top off" and run TSTT. How and who to provide 7 Consider NO lead. <br />_ <br />Telephone <br />Terminal or other contact <br />for not" or irpu;ry <br />Company Nerve <br />Telephone <br />10. CONTRACTOR, <br />MECHANICS, <br />any othw contractor <br />involved <br />11. OTHER <br />INFORMATION <br />OR REMARKS <br />Additionalm <br />inforation on any items above. Officials or others to be advised when testing is in progress or completed. Visitors <br />during test etc. <br />Tests were mads on the above Um* systems In OCCOMIence with test procedures prescribed for orfro�}� <br />or observers present <br />12. TEST RESULTS <br />as detailed on attached teat charts with results as follows: `�—•' <br />Tank Identification Tight Leakage Indicated Date <br />Tested <br />es I + . e'� 3 i A <br />- ' - 1Z �. <br />13. CERTIFICATION the � National � Poen tested on the do«s) shown. Tho.. Irwleated .s nohr meet me «rt.rf. estaafshod ey <br />AsOcifirtiOnmphbst 329. <br />Data �/SE�- /-/c--,u A lU 0 C= z— LC I <br />(�� Testing Contractor or Company. By. Signature <br />s.nv No. a Th«m., 4r R TechhnAAme - _ P- 0. Box 1220, Thiara , A <br />