Laserfiche WebLink
f est Keport <br /> C!�JSP TANK TESTING , uinderground Storage Tank <br /> l_w <br /> • 2004 PICCOLI 09 � �� HORNER SYSTEM <br /> 7JOCKTON, CA 95205 <br /> APR 7 <br /> ENVIROMENTAL HEALTH <br /> OWNER OF SITE 6iz-/6G�t 6 �s� L:.ED/1eP ��c,c�vcr��_ PERMIT/SERVICES <br /> AuDRE55 OF UwNER�( �16 sI y .9Sf///VC;T- _C l T� Ta�� "'�STATE C ZIP <br /> OWNER OF TANK <br /> ADDRESS OF OWNER /��,�Dxl/ f'YfiSy��✓C;T��►!�C 1 TY ,�• �/ STATE _7 I P �S�z4 _ <br /> NAME OF OPERATOR AT LOCATION L G� _P4R <br /> ADDRESS OF LOCATION C•Zocke Rd CITY k Fo D STATE�_Z!P 3 <br /> NAME OF COUNTY <br /> TANK n _ON PLOT PLAN LOCATION. STORAGE SYSTEM FILLED: DATE -10e}'7rT7ME l OO <br /> DATE OF TEST TIME OF DAY: START Q r/Sa FINISH / 05� <br /> LENGTH OF TESAIR TEMPERATURE <br /> "' "o V y3•,• METAL F I BERGLASS <br /> O I SCRIPT 1 ON OF TANK-CAPAC I TY.3-/o aoo DIAMETER-'; - <br /> - 9 - <br /> YPE OF SYSTEM- SUCTION X SUBMERSIBLE OTHER <br /> TYPE OF VAPOR RECOVERY SYSTEM �VDA/F <br /> ..9- 33• <br /> TYPE OF PRODUCT BEING TESTED A ESC` MEASRURED GRAY I TY,3-, 23 C 0 E F F I C I ENT , <br /> TEMPERATURE OF PRODUCT3- LFp <br /> MEASURED WATER IN TANK -2 -- _ DEPTH OF TANK TOP FROM GROUND LEVEL... 3d/ <br /> DEPTH OF GROUND .WATER 4, HEIGHT OF LIQUID LEVEL IN TEST STAND OR STAND PIPE <br /> AGE OF TANK AND LINES 5YE-4RS <br /> RESULTS OF TEST: CERTIFIED •TlGH YES �i0� IF 0 EXPLAIN IN REMARKS BELOW <br /> LEAP, RATE PER HOUR: + <br /> 6 <br /> REMARKS BY OPERATOR <br /> NAME OF OPERATOR <br /> SIGNATURE OF OPCRAT <br />