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(IIIIIIi Champion <br /> ` P.O. Box 13059 <br /> Sacramento, CA 95813.3059 <br /> Preciston Tank Testing CA 800-660-9443 <br /> Ucenu No. 73848 <br /> NEV 800-949-9443 <br /> (916) 927.1557 <br /> Fax: (916) 927-7345 <br /> HORNER EZY-CHECK CERTIFICATION <br /> Owners Property Tanks(s) <br /> Company &,4 e F 7-RPhone_(_) <br /> Address TK4+ * FS UD <br /> City TWA r State- C>A. Zip <br /> Name & Location of Company <br /> Company ,-'42A 5; r ec,-w,� 5<gaA cva-4 Phone_(_, <br /> Address San Tore 57 <br /> City State I t Zip <br /> NOTICE TO OWNER(S)I A COPY OF THIS TEST RESULT HAS BEEN FILED WITH THE PROPER REGULATORY AGENCY, <br /> WHICH IS REASON FOR TESTING <br /> 'NOTICE'IT IS THE RESPONSIBILITY OF THE OWNER(S)TO CONTACT THE LOCAL ENV. HEALTH DEPT.,IN <br /> HIS/HER AREA OF ANY TANK FAILURES WITH(24)HOURS. <br /> Who requested When? <br /> Identify by LD Product Capacity Apx. Age Steel Fiberglass Brand/Supplier <br /> I i>=SEZ larJo �— <br /> Tanks to be filled Date: 5, -z>-f C- Time: <br /> Distributor - c dRY� Extra Product to top off mac, <br /> Comments <br /> REPRESENTATIVE(S)OR OWNER(S)WILL BE NOTIFIED WHEN THE TEST HAS BEEN COMPLETED AND ONE OFFICIAL MUST BE PRESENT OURNG <br /> THE TESTIt*. ALL TESTS MADE ON THE TANK(S)SYSTEMS ARE VAUD THE HORNER-E:. CHEK LEAK DETECTION PROCEDURES. <br /> THIS CERTIFICATION SHOWS THE CRITERIA ESTABLISHED.� DB�BY THE NATIONAL FIRE ASSOC.(PHAMPLET 329). <br /> L7 <br /> Test Results Include Tank(s) 'Line(s) 9?1' apor Recovery System ❑ Vent Line(s) [J-- <br /> Tank <br /> '7`Tank Tight Tight Leak/Per Hr. Leak/Per Hr. Date Tested <br /> ID# TankLines Ind. Tank Detected Line <br /> / Y 8-IN ❑ Y r1rIN ❑ },or0t <br /> Y ❑ N ❑ Y ❑ N ❑ <br /> Y ❑ N ❑ Y ❑ N ❑ <br /> Y ❑ N ❑ Y ❑ N ❑ <br /> Technician: Certification <br />