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KORNER EZY-CHEK TANK CERTIFICATION <br /> CHAMPION PRECISION TANK TESTING (916) 927-1557 (800) 660-9443 <br /> LiC # 73048 (800) 949-9443 Nv. <br /> Property Tanks (s) <br /> OwnersCompany�_} /`4autH S�uAPrS� _Phone_CnL)_ `r_3Y/ ---- <br /> Address!_ !3 i ill rte[f1 t --____ Cts, Zip ' 'I <br /> City'_—STccx r0 xJ —__ - state t_ -- -- -- <br /> Name & Location of Company! <br /> ���E Phane!_f_ <br /> Company: <br /> Address0_ State : ZiP � --__ <br /> City) ---- -- _ —_ <br /> -- -- - 037" "Of r`OW s[stw.■"my aataeT. WNTC0t <br /> aoTsrs TO 9rsdt to s ■ csrT err TTars TtaT 0t9t1LT 04:[0. FILES 037" <br /> 411 ataeaw 9a++ ren TLa - <br /> . srttat. rT 19 TIK ■urw.+=atasrr ur Ttr[ 9...talas To Cs.TACT TK LOCAL ay. MEALY" acrT• in <br /> K16"N Tt aa[a or ■0T TalaC /■ILU1t[a Orr" 1741 1tpt0■9. <br /> Who Requested & When?—_ -- ----- <br /> Tank results Inc. Tank aProduct Line,L''dVent Line+LD vapor Line ❑ <br /> Identify Capacity Brand 'Grade Age Steel Fiberglass <br /> by ID# I <br /> ! l ! I I ✓ <br /> Sad 731 C,SFL _I l !—�•'" <br /> - <br /> 1 <br /> Tanks to be filled ! Date, —Timei — <br /> Distributor! 3s x«Mr __..._Extra product to top off :'z0 C.c,-L — <br /> Comments! <br /> asrwtaa.Tlvenrs a...ta+u WILL at "*TtrTta w.[s "M TKOT P■0 Me" CepV%j'ss ara 9wt OIr1[T■L su9T <br /> >'T9Ta�0■ !Pt <br /> St HttataT @400100 TTRTt00• alL T[■T■ "AMC 9" T"C Tpw0/91 ar Toa( 1.00K0_ Ca.lY <br /> FI <br /> 0@4 <br /> 1.[^X WTYCTI" raOX9UIt[9. 7MT9 CLOtTTrTC■T1a0 9.400 Tit CaTTZR^ [9Taal.la0t9 9T TW 11■TS90■L /10[ <br /> •9990. 1r't0■0'�L[T 1111. <br /> Test -Results Inc. Product Lines, Vent, <br /> Tank I Tight I Tight I Leak/Per Hrl Leak/Per Hr. I Date <br /> ID# I Tank I Lines ! Ind.Tank I Detected Line [Testing <br /> �yN ❑ 1 Y/ /2-2Z ? <br /> —L --I YL �N0 <br /> ! YQN01 YD ND <br /> ----I Y ❑ N 0 1 y ❑ N D <br /> ------I Y C3 N 1 Y_ ❑ N ❑ <br /> �� Y ❑ N ❑ 1 Y ❑ N ❑ <br />