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Data Charter Tank System Tightnesfest <br /> 5E PRINT CHAMPION'; I-SIGN TANK <br /> OWNER Property ❑ AMFRICAN SAVINGS. - - Rrvtearnutwe T«rvnen• <br /> Nam. ddreaa <br /> Tank(s) ❑ ATTN: Transportation Dept. <br /> V,CI{ R•vtraentnrve T«rvhona <br /> Address <br /> Nam. <br /> 70 <br /> x1 <br /> T«aphe n. <br /> OPERATOR ,+ . /. iiJ `�✓� R:o: fi <br /> Mem• „r Address <br /> REASON FOR EEGuLAT,1ON GOVERNING UNDERGROUND STORAGE OF HAZARDOUS SUBSTANCES <br /> TEST SUBCHAPTER 16 OF CHPATER 3 OF TITLE 23 OF THE CALIFORNIA ADMINISTRATIVE CORE <br /> (Explain fully) <br /> OWNER <br /> 'WHO REDUESTEDCompany Or Affawtron O•t• <br /> Nam. TrtM <br /> TEST AND WHEN T«.phone <br /> Add—% <br /> Air <br /> WHO IS PAYINGOWNFE Trite T.r.pne to <br /> Company.AQrr,cv or tnd—d.41 Person AutndnrrnQ <br /> FOR THIS TEST? C„y Sul* Z.p <br /> eimrmg Address - <br /> Ane"pfl 01: <br /> Order No Otnar fnstruetrona <br /> Stee/frbef Ins <br /> identify by Direction Capacity Bra ndlSuppher Grade Approx.Age i 0 <br /> TANKS) INVOLVED o %O-K ("aa n i' 1 ., 0 I-_) <br /> Location Cover <br /> Fills Vents S+phones Pumps <br /> INSTALLATION /r .4,eQ sr <br /> DATA � ;� o <br /> o,_3 T d Y Suctaon.Ramat.. <br /> s Meke if known <br /> NoAh inside d,Y vY. Conctete.Black Top. Sire, es.A!Take,Drop yyn ch tank$. <br /> Rur of■ration,ac. faun,mc. Wera.Remote Fdk Saa,MendordW <br /> Is the watrr over the tank <br /> UNDERGROUND ❑ yea ❑ No <br /> WATER Depth to the Water table <br /> Tanks to be filled h, /Z -G_2P Date Arranged by G'u `r Noma Televhona <br /> FILL-UP <br /> Extra product[o"top off”and run$STT. How and who to prowde? Consider NO Lead. <br /> ARRANGEMENTS <br /> Terminal or othel contact - <br /> for nonce or inquiry Nam• Terrohone <br /> C4m0e^V <br /> CONTRACTOR. <br /> MECHANICS. <br /> any other contractor <br /> tovolved <br /> OTHER <br /> INFORMATION <br /> OR REMARKS --- --- - <br /> Add.u0nal inlormal-on on any "e-5 anove O1he�ais or othe,s to be ad-sed when telling rs in progress or Completed.Vintars or observers present <br /> du,�ng test eic - <br /> Tests were made on the above tank systems to accordance with test procedures prescribed torl'I±;.TRO 'SITE <br /> TEST RESULTS as Oetalled on attached test +:harts with result%as follows! <br /> T,ghl I Leakage Indicated Date Tested <br /> Tan1 IdenhLcas,on - -.- 4 0 <br /> — a <br /> 4 <br /> This is to certity that these tank systema were tested on the dates}shown.Those indicated as"Tight"meet the criteria established by <br /> CERTIFICATION the National Fire Protection Ascciation Pamphlet 3M <br /> C,HAMPION'S PRECISION TANK TESTING <br /> oat. 2308 HARVARI3°' 4n�na RAl�BTOBY CA.Q^a�°�815 <br /> Sar.ai No et Trsemna7 lei nn�r.a^t — <br />