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mplvn <br /> r pretISIO Test lt>t9 <br /> 1 Lk*IM S . 73848 <br /> —' DATA CRABT FOR TANK SYSTEM TIGHTNESS TEST <br /> PLEASE PfifPiT - <br /> 1. OWNERTur**JED <br /> Sip �.ar..arrSau.e Te,eph" <br /> TatapAorw <br /> T <br /> arrr Addran Zip feaPraaa^�1e'a <br /> BRAD T05CANA 1444 SOUTH LINCOLN ST. STOCKTON, CALIF <br /> F. FRET111-111''ll2 OPERATOR Waren Addra� zo si ^e'y <br /> REGULATION GOVERNING UNDERGROUND STORAGESUBSTAN ES <br /> 3. REASON FOR ATIVE <br /> TEST SUBCHAPTER 16 CRAPTER TITLE 23, OF CALI 0ADMINIS <br /> ++ <br /> lEripWn€AW CODE: <br /> 4. WHO REQUESTED Wanr. Tal. G'Oi""n+'or A,Niscon Date <br /> TEST AND WHEN <br /> Addr�a ziP Talapfwm <br /> leo5hla OvarYion CJa+tcitr gr�rrd/$rrpptw Grade 7Er <br /> 5. TANK INVOLVED 4 000 <br /> ur+addhbrt�NOW <br /> for mwdlokW to-" <br /> twn ' <br /> 6. INSTALLATION FRONT BLACKTOP 3" 2" WITH BENNETT <br /> DATA OF VENT SUCTION <br /> BLDG CAPS <br /> F N the Walar O.er the tank? <br /> 7. UNDERGROUND <br /> WATER Depth 10 the Water table l(cm Wade BELOW TANK / WELL POINT ❑Ya' ED NO <br /> 0700 1/22/93 <br /> Tanks to be Bead M. Data AffWV*d W Wama Taraphone <br /> 8. FILL-UP <br /> ARRANGEMENTS Extra Product W4So-WP Otr w run tank tester. How OW who m provida7 Can+ear NO " <br /> TESTING CO. <br /> Tarminr Of ao+a mmsd <br /> Stir nd,iCe or wxpmy camp" Nome Tempho" <br /> 9. CONTRACTOR, <br /> MECHANICS, <br /> saw othw eontncfor <br /> ln.owad <br /> 10. OTHER VSKILFEVELING STANDPIPE AND DTS. 2,000INFORMATION <br /> OR REMARKSrrnatron on any i,arrrs atwva.Q,livafs orOlharaloa.Mined~,astirgisinProgressoroornpWred.Visit %Or ohsan�an PSN Ornrnyless.a,c. <br /> 11. TEST METHOD O TITh * 2 0 PETRO COMP QUICK CHECK 2000 <br /> Twit worn mods on the Abiwe Unk sysi m.in w=Mdrloa,rO WM proc@du—p—albed for <br /> 11a. TEST RESULTS m daLs"d on anmdwd feat dw%wkh r"AIX m NAMM: -- <br /> T0m MildHokarn Cttan7a PW Fora. Data Tested <br /> Tr+k rd.n,i,icriron <br /> 1/22793 <br /> UNLEADED SOUTH PASS —• 023 1 2 2 -'9 3 <br /> 12 SENSOR <br /> CERTIFICATION <br /> 1123192 -Dow K. CPB L CHAMPION'S PRECISON TANK TESTING <br /> 418 f 92-1324 P.O. BOZ 13059 SACRAMEIM CALIF. <br /> a <br /> 915-927-1557 -- '1-800-560-9443 CALtF• <br /> SACRAMM TO 1-800-949-9443 NEV- <br />