Laserfiche WebLink
a <br /> HORNER EZY-CHEk_TANK CERTIFICATION_REPORT <br />_ CHAMPION PRECISION TANK TESTING (916) 927-1557 (800) 660-944.3 <br /> License #73848 <br /> Owners 3 roperty 9<ank (s) <br /> Company _S�u .-iZ4at% ss-�uYi? Phone_ <br /> Address;_y7LQJ_-9 DkrJ r3 ---------------------------------- <br /> Ci t a__-S2d1Q­1,�-D _ State ___[----------------------------- <br /> Name <br /> _-Name of Location <br /> Company: eo�u �s -_De&'a-P-----------Fhone-(=?.M ) <br /> Address:__j_ys(_i5 �- ----------- <br /> ----------------------- <br /> Ci tY _5 � c�----^---- State : q..f Zip ! ---------- <br /> Notice-to_owner (s) . A copy of this test result has been filled <br /> with Proper Regulatory Agency. To: __-__ <br /> ------------------------- <br /> Reason_For_Test :---------------------- <br /> --------------------------- <br /> Noticel It is the responsibility of the owner to contact the Env. <br /> health Dept. of any failure on tank (s) within {24) hours. <br /> ----------------------------------------------------------------- <br /> Who Requested & When? ---- <br /> --------------- _-------____ -------------- <br /> Date ; <br /> r-E']"�roduct Line ©dent Line O Vapor <br /> ^ r -- - <br /> GaTank Only Line []All of these <br /> Identify: Capacity brand ; Grade Age: Steel Fiberglass <br /> by ID# a Supplier : <br /> __----- ---_ ----- - ; -------- -------------- ------------ <br /> 1 ------------ <br /> ----------- - -- ------------ <br /> I <br /> 1 i 1 1 I <br /> --------------1 ----__------ <br /> ---------- -------- -------------- `------.------ <br /> - •+-----------1 -------•. ---- <br /> Tanks to be filled : _ i a o a ------ For : ----------Date ;----6---Q-3 <br /> Distributor _ - <br /> -- <br /> �L.E_?��L sy_nzr.�►�,fl Extra to tope—off <br /> Comments______________ -___ -------_--___ <br /> --------------------�_--------____Representives or owners will be <br /> notified when the test is completed and one offical must be <br /> present during the testing. All tests made on the tank (s) systems <br /> are valid with the Homer Ezy-Chek leaf; detection procedures. <br /> This certification shows the criteria established by the National <br /> Fire Association [Phampiet 3291. <br /> ------------------------------------------------------------��-------- <br /> Test Results Tanks,Product Lines, Vent, Inc. I/Yes ❑No <br /> Tank Tight Tight Leak/Per Leak/Per Date <br /> ID# Tank Lines Ind. Tank Detected Line Tested <br /> -- ' ---------' --------- ' ---------------C---------- <br /> --��r -; -Y e N ❑ YO"N❑ - <br /> Sa�T�— <br /> YO N W- ! YR-N❑ 1 ---!7S9--- -- --- -La r z, -f_ - `2 -43 <br /> ------ Y ❑ N ❑ Y© NO :---------- ; ---------------- ---------- <br /> -------- Y ❑ NO YO NO o------------ ---------------- ;----------- <br /> ------ Y 0 N C YO NO :---------- --------------- ------ <br />