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a <br /> OIL EQUIPMENT SERVICE STATE LICENSE No.323417 <br /> CLASSIFICATION: A-HAZ.,C61D40 <br /> Division of Keith A. Tallia, Inc. STATE ENVIRONMENTAL ASSESSOR No.01781 <br /> Telephone: (209)754-1808 <br /> Fax: (209)754-5726 <br /> Post Office Box 950 <br /> 750 Industrial Way <br /> SAN ANDREAS, CALIFORNIA 95249 <br /> HORN£R EZY-CHECK CERTIFICATION <br /> Property <br /> Owner: 7-zc K TG til <br /> Address : c� Lv_ �_/.QSfi'r ti 6-7� 07-Z,_Kn ry r e,4-, <br /> Tank Address : <br /> *Notice to owner(s)* A copy of this test result has been filed with the proper regulatory <br /> agency. It is the responsibility of the owner(s) to contact the local Env. Health Dept. in <br /> his or her area of any tank failure within (24) hours of testin;. <br /> Tank Product Capacity Apx . Age Steel Fiberglass Supplier <br /> cr A,c tF A Di 1) 1,-2 od o v <br /> Tank(s were filled on : -Distributor :- <br /> Date <br /> istributor :Date Time <br /> Extra product to top off :_No[cY Yes[ ] Gallons <br /> Comments : <br /> TEST RESULTS INCLUDE <br /> Tank(s ) Product Line ( s ) c— Vapor Recovery System Vent Line(s ) <br /> Tank Tight Tight Leak indicated Leak indicated Date of <br /> ID# Tank( s) Line( 2) per hr. ( tank) per hr. ( line ) testing <br /> yc►J[c- i?`PYes[0o[ ]Yes <br /> a[ ] -Y4-, o.�J,73 <br /> Yes[&, No[ I Yes VfNo r3 – <br /> __�Yes[ ]No[ ]Yes[ ]No[ ] <br /> Yes[ ]No[ ]Yes[ ]No[ ] <br /> �Yes[ ]No[ ]Yes [ ]No[ ] <br /> YeS[ ]No[ ]Yes[ ]No[ ] <br /> Date : <br /> Technician : T2- " �� License – r3- � <br />