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Holla mi ! CHAMPION <br /> TANK CERTIFICATION Rr"IsiorrTank Testing <br /> Y <br /> P.O.BOX 1'-59 <br /> kak detector REPORT Sacramento,cA95813.3059 <br /> Property 13� T2 y:)n /> S ` t[ -f 1 t' - !}!� ! T 'i= <br /> OWNER'S ,ams <br /> NAME Tanklsf C �? r. ,.> fJ� �' T•�. �� `3 n <br /> warns Coy Zip <br /> NAME OF f'1_ - <br /> rte�e teterrwrw <br /> LOCATION <br /> Aaaew Coy Zip <br /> NOTICE TO OWNER A copy of all test reauta have been filed with the proper regulatory agency governing underground <br /> storage aystarns. Yes ❑ No ❑ If not filed, see axpianabw beiow. <br /> RECORD OF <br /> FILING <br /> Location of agancy where filed-, -- <br /> REASON FOR <br /> TEST <br /> mxroae1 Fury) NOTCE It is 'the orrw's roopwa+tty to contad the emlromtentai beam department of any bakoas vrthit 24 hrs.of the resuiti <br /> given to the owner. <br /> WHO REQUESTED wm. <br /> TEST AND WHEN? <br /> �eansr � <br /> ppr Aq� <br /> kMrrr d►Dw•taa++ Capw" &"'4f 5 4v�"' Graft �,to k++eu ni r F piqued••• <br /> d.warn l0e <br /> ITE)A OR SYSTEM I t:TI <br /> TANK ONLY 0' <br /> 0 Cl <br /> FgDPUCT UNE e' <br /> WN1 uNE a' ❑ 13 <br /> YAPOR UNE 0 0 ❑ <br /> ALL OF THE ABOVE . 0 0 0 <br /> Tanks ra be seed <br /> FILL-LIP <br /> ARRANGEMENTS <br /> rbr.a <br /> Eua w0dud a-op or M <br /> OTHER <br /> INFORMATION <br /> OR REMARKS <br /> A44q.onal inwrnatgn on any+r..nr ace"Oftwe a armor,b be assess>rRert ferarq K in progress or con okpied Views or Odse+vers presom during <br /> lost etc <br /> Irmo none meds ew ere above tont synod r accordance wret Nesta MY Chock coat Oetocden beet <br /> TEST RESULTS for an on ar.died b.r assn eget r mad.So t.r..r: <br /> Tans brrrdr+n. Twa tw* Tqm Lara Laver,"urea./Tara Lawn.rnecetiM Lommr Curie f4WA d <br /> TANKS vee fr�w a as 0 No 0 .a 3 2 <br /> MWCT LINES yes a "a G res a )a a <br /> -*W vent Yes Tee 0 No a via 0 he a <br /> Lines Included No 0 v.s 0 Fra 0 ves G w ❑ <br /> Y.s 0 No ❑ vee f."'+ No 0 <br /> CERTIMATM The is bMe the"tank weeder vera terve] on Via date(.) rhown. Those Indo Wd ae Ti�#+P etret the ertrrts estalfahed by . <br /> the National Firma Prgtidlon Aseodnhon Pw*"3M- <br /> Date <br /> L� ,s!/Lwufznl <br /> _. Technicians: <br />