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Sacramento Equipment Mattenance Company Inc • <br /> 2533 Connie Drive Calif.conn.License#5=77 <br /> Sacramento, CA 95815 wo d, 54030 <br /> PLW 9RINT 5 Data Chart for Tank System Tightness Test Station 1334 <br /> ' PLEASE PRINT <br /> 1. OWNER Poop"D Circle K Corp. - Environmental Dept. - 3437 Myrtle Ave. Suite 440 <br /> Tarwal❑ N.m. North Highlands, 'a. 95660 Craig L enter (916M-2540 <br /> Hent Aderaw RapnwnwM - rNaplbn. <br /> Z. OPERATOR Store TO 34 — 265o Mt. Diablo St. Stockton Ca. (209)465-4763 <br /> .... No. Adobes, TNapn«r <br /> j 3. REASON FOR s .stem integrity <br /> TEST <br /> - (Explain Fully) <br /> 4. WHO REQUESTED <br /> same as #1 <br /> TEST AND WHEN N"'" TM" w!Ivaq«AnnlNbn oNe <br /> jAddnra T.Lp,«b <br /> Identify by DkWhom Capacity Bnna.BuuppllAr Brats Approxet•N/FIe•rplm - <br /> 5. TANK INVOLVED a ....` �! 7 l_ 2lBQ l <br /> Uw Wdltkmat Ewe <br /> for manllNd.d tanks <br /> Location Cow Feb Vanua &phones Pump• <br /> 6. INSTALLATION e� 49 Z r6d <br /> DATA def <br /> i <br /> NOM bat ohew.y. Co..•.Black Top. Tea..Tile""make.0,19 B•nwte. <br /> I <br /> Wer N aWbn.Na E.M,IN b ma.Wmob Fee �.kbnibkl.d YI tanker wk.■known <br /> 7. UNDERGROUND �� b WwN««w er bN9 <br /> WATERI� ❑v« Ow <br /> ppmbM WeterbW . <br /> b' <br /> 8. FILL-UP *wubaaa.d M. out. Artrq.o, Nrlr TN's'""' . . <br /> ARRANGEMENTS EM poduct VW off"and run faek upbr.How and who to PONde7 Canbw NO Land <br /> I , <br /> I Tared"«wine,cmba - .. <br /> Ior aeec.«MNrY <br /> .' Company _ Hem. —. 7Neptwb <br /> 9.CONTRACTOR, <br /> MECHANICS, <br /> bombedreankactu - <br /> InyoPM <br /> 10. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> w� <br /> AMNWW M mlmbn an a„y Wm.abora Bnbue««Mn b be edrwd N,et WNbp Y In Program«oompww.Vbburs«oba.,r«.geae, AAbp We%W. <br /> Tesla were made on the above tank systema In accordance with test proeeddro,s�f�ss�e�6ed tor. <br /> 11. TEST RESULTS .i sa detailed on attached test chert with results as follows 'Std: t ' <br /> / t 4 Cuts Tooled <br /> TW bmtllkai4m c: Tlplll laakaaa kMkNM <br /> .✓ <br /> 12..SENSOR 13.This is to certify that thane tank systema were tested on the date(s)shown.Those Indicated as"Tight"meat the criteria established by <br /> 'CERTIFICATION ,: the National Fire Protection Association Pamphlet 329:. ,. <br /> Technicians it is the responsibility of the«mer andl«opendor of this system b Immediately advise Nate and boat auawdfies of wry - <br /> r . Implied hazard and the possitAfty N any nidtittable pollution to the enrironmenl as a result of the IndiMed hilum of this <br /> R •Outs system.Heath Cmnullenb IncoMond for SACRAMENTO EQUIPMENT MAINTENANCE COMPANY,INC.does M <br /> eesume any responsidliy«aabp' o y Ices of pmducl to the environment. <br /> B.,Itl Ila of Ihwnlal Cereepaaan <br /> Baoa« .. L„^ <br /> 1If <br /> Cwtla <br /> h <br /> +,o, r{ pflbls Tank Owner/Operalm ,( Daletiol <br /> ��. <br />