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�r✓� Data Chart for Tank System T►abtness Test <br /> petro Tito <br /> PLEA SE PRINT ANI K TESTER <br /> 1. OWNER Property ❑ B . J . J . Company <br /> Tankls) ElYl+!Il E . Mariposa Road Stockton CA 95206re..nlal y. Tu.pho,. <br /> Mame Addrm 114nowntetiva Tatanhorre <br /> 2. OPERATOR B . J . J. Company-2431 E . Mariposa , Stockton CA <br /> Nem. Address Taapn... <br /> 3. REASON FOR Re ulations governing underground storaae of hazardous <br /> TEST substances , subchapter 16 of chpater 3 of title 23 of the <br /> (Explain Fully) r-alTfornia Adminstration Code. <br /> 4. WHO REQUESTED Forest Shaw , Owner Shaw Maintenance 6/08/87 <br /> i Company or Purifies.TEST AND WHEN P945 Fulkerth Road , TurTlock , CA 95380 209)668-8441Due <br /> Address Telephone <br /> 5. WHO IS PAYING Shaw Maintenance Forest Shaw Owner ( 209)668-8441 <br /> FOR THIS TESTI 1`&n��'""�°u`Y9CIen0i Fi Road . TuN cCo"Ta 95380 T.O. Telephone <br /> aiding Adores. City Null Zip <br /> Atlantic,of: Order No. Other Inelwctions <br /> Identify by Direction Capacity Brand/Supplier Grade Approa.Age Steel/Fiberglass <br /> 6. TANK(S) INVOLVED 44 1 11or-4-L 12 , 000 OJA Diesel <br /> ad - Se.�1u 12 , 000 Diesel /Vrµ� <br /> Lootion Cover Fills Vents Siphon, Pumps <br /> 7. INSTALLATION NOR7-r4 CFs+frn7' y 'r ,2 D Pl?OVUC7'' te�,"'07E <br /> DATA ( /� S T' of FfNC£ /lyfs 7'a A,' 7 8! <br /> OFrlC£ otzlo <br /> Norah inside driveway. Concrete,Black Top. Size,Thefill make.Drop Suction.lemma. <br /> Rear of station.etc. EaM,etc. tubes.Remote Fills She,Manifold" Which lanks 7 Make if known <br /> S. UNDERGROUND p(� c / ,Af y� Is the water over the tank? <br /> WATER Depth to the Water tsble &f^QW T/ /1(-,v L3o77�D rI ❑ Yes ® No <br /> Tanks to be filledo&x, h, Det. Arranged by r2. rJ_ 7_1341CALiI4; <br /> 9. FILL-UP Meme Telephone <br /> ARRANGEMENTS Earls product to"top ole"and run TSTT. How and who to provide 7 Consider NO Lead. <br /> Terminal or other contact ,/ ,s <br /> for notice or inquiry /Y If <br /> Coolish, Mame Telephone <br /> 10. CONTRACTOR, r - — <br /> MECHANICS, " <br /> any other contractor ^ I {1 <br /> involved <br /> 00i <br /> J i <br /> 11. OTHER <br /> INFORMATION ENVIRGIMENTAL 'HEALTH <br /> OR REMARKS <br /> Additional information on any items above.Othcl s when teeing n in progmss or completed Visitole or observers pesem <br /> dwing teal it <br /> Tests wore meds on the above tank systems in accordance with test procedures prescribed for s►tro T�f <br /> 12. TEST RESULTS as detailed on anaehod teat charts with results as togows - <br /> Tank Identificabori Tight Leakage Indicated Oat*Tasted <br /> S _ - —r 9 <br /> S i <br /> This is to caeuty that thew tank systema were Weled on the delete)shown.Thws ttldtcated as"Tight-Brat the crtlerle NIabMNW h <br /> 13. CERTIFICATION the National Fire Protscoon Asoclatlon Pamphlet 729. <br /> 7Ie_'.Sg—.. 07!/A/ G/. ON___ EHVIh0134ENTAL PETROLEUM ENGN. <br /> Data -- --I -lip;-one i—�ongne y NnetuM - <br /> r _ P.O. 00X 2076, SIOCKINr CA 4§ibf' <br /> (109J9431022 ----- Mt7d,ese - <br /> sarrn <br />