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TANK CERTIFICATION REPORT** ] CHAMPIONS PRECISION TANK TESTING f <br /> (916)649-3677 P.O. BQ&13059 <br /> CALIF. 1-800-660-9443 SACRA,MW, CALIF. 95815 <br /> NEVADA I-800-949-9443 FAX: (916) 725-7345 V <br /> OWNERS NAME J <br /> NAME: Z.' PH b — 3'1 <br /> Property p ADDRESS: 2� 19 repo;5c.> (7 <br /> ank CITY : rn-0(2K STATE: ZIP: ` 1Z 0 Z o <br /> NAME OF LOCATION NAME: e-1 <br /> - ADDRESS; <br /> CITY: STAT <br /> NOTICE TO OWNER: A copy of all tests results have been filled with the praper m <br /> RECORD OF <br /> FILING regulatory agency governing underground storage systems. G <br /> Yo N Q If not filed, see ex laination below. <br /> r <br /> ra <br /> c., <br /> Location of agency where filed. <br /> i <br /> :3- <br /> REASON FOR TEST <br /> (explain fully) <br /> NOTICE: It is the owner's responsibility to contact the environmental health �* <br /> department of any failures within 24 hrs. of the final results. <br /> WHO REQUESTED NAME: PHONE: ( ) <br /> TEST AND WHEN? ro <br /> ADDRESS: <br /> CITY• STATE: <br /> ITEM OR SYSTEM Identif b Capacity Brand/Su tier Grade Apx Age Steel Fiberglass <br /> TEST o <br /> Owner y y P Y PP if knownro LA <br /> 2 <br /> TANK ONLY ® `` <br /> PRODUCT LINE © tDC* <br /> VENT LINE o *� <br /> VAPOR LINE <br /> ALL OF THE ABOVE �' A <br /> L <br /> �o <br /> FILL - UP Tanks to be filed. for Date <br /> ARRANGEMENTS "a <br /> Distributor Q = <br /> Extra Product to 'top off' Y= N o Namezr <br /> ro <br /> OTHER f:0� <br /> INFORMATI Ok C)� <br /> OR REMARKS <br /> CL . <br /> Additional information on any testing above. Official 's or others to be "v <br /> advised when testing is in progress or completed. Vistors or ooservers <br /> present during the test. <br /> y <br /> C(* <br /> TEST RESULTS Tests were made on the above tank systems in accordance with Horner Ezy <br /> TANKS Check Leak Detection with procedures prescribed . Results are as follows: rte+ <br /> PRODUCT LINES an ht Tank Ti ht Lines Leak/Per Hr. Leak/Per Hr. Date Tested <br /> VENT & VAPOR Ind, TanT__ 7ne E� . <br /> LINES INCLUDED Y N C:D Y 90 N a 0'0' <br /> Y Q N © T cz) N C5 T o R K <br /> o N Y Q <br /> Y <br /> 7Y NY r.� <br /> w <br /> 0 0 <br /> ig <br /> ERTIFICATION: <br /> e <br />