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39 _ 19 3 Data UP for Tank System TightnA Test <br /> petro Tote <br /> PLEASE PRINT TANK TESTER <br /> 1. OWNER PropertyMcCormic & Baxter, 1214 We Washington, Stockton, Ca <br /> Tank( ) . 95'p2� <br /> ® Name Slime as above Address gepresentahr. (209) 4`�/ !l` 1poq67 <br /> Tanks) <br /> Name Address Reprasenutbe Telephone <br /> 2. OPERATOR Same as above_ <br /> Name Address Telephone <br /> 3. REASON FOR <br /> TEST Qat if orni n Stntp Taw <br /> (Explain Fully) --" <br /> 4. WHO REQUESTED Larry Shiba 4/24/87 @ 10:23 <br /> TEST AND WHEN Same as above Till. ComwnyoUlldiation 209) 46� o�ty 67 <br /> Aptness Tel.phim. r <br /> 5. WHO IS PAYING Same as"_above _ <br /> FOR THIS TEST? Company.Agency or Individual Person Authorizing This Telephone <br /> Billing Address City Sul. Zip <br /> Altenlion ol: Oldel No. Omel lnebugtions <br /> Identify by Direction Capacity Brand/Supplier Grade Approx.Aga Steel/Fiberglass <br /> 6. TANK(S) INVOLVED Unknown 550 -CAE UL Gas Unknown UnIcnown <br /> Location Cover Fills Vents Siphoning Pump fV, <br /> 7. INSTALLATION See -ro <br /> DATA RWW7-2 Earth 2" 1 z" none IJ <br /> North meld.driveway, Concrete.Black Tap, Size,Tltetill make.Drop Suction,Remote, <br /> Rear al chums,etc. Earth,etc woes.Remote Fills Size.Mandolded Which tanks? Make it known <br /> B. UNDERGROUND Is the water over the tank? <br /> WATER Depth to the Water lable f D �� -. D Tax No <br /> Tanks to be filled Prigr to art aall�alArlanlud by / — <br /> 9. FILL-UP N.m. T.I.,hone <br /> ARRANGEMENTS Extra product to"top off'and run TSTT. How and who to provide? Consider NO Lead, <br /> Terminal or other contact <br /> for notice or inquiry <br /> Company Name Telephone <br /> 10. CONTRACTOR, <br /> MECHANICS, <br /> any other contractor <br /> involved - "" ---------'- <br /> 11. OTHER Li��� J k cS�I1c2�U. £Ar Q` /C-f_S AlY7 t/f 7Ro <br /> INFORMATIONage <br /> OR REMARKS <br /> Additional information on any items above.Officials or others to be advised when testing is in progress or completed.Visitors or observers present <br /> during test etc. <br /> Tests were made on the above tank systems in accordance with test procedures prescribed for pe <br /> T11P <br /> 12. TEST RESULTS as detailed on attached test charts with results as follows: T"' iR <br /> Tank Identification Tight Leakage Indicated Date Tested <br /> Passed -- - ----- <br /> Failed <br /> Cert. <br /> la Itil Ll <br /> Copy <br /> Vista- <br /> Paid MAY 15 1987 <br /> Charg c� <br /> Inv. 3 9 - 19 3 ENROMENTAL FIERMIT/SERVIC SLTH <br /> County <br />