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petro Tde <br /> PLEASE PRINT . tANK TESTER 1 ,I <br /> 1. OWNER Property ❑ Circle K Corporation Pat Wright ( 916 ) 334-2445 <br /> N.m. AdmW Wxee raNpnotW <br /> Tank(.) El5811 Manzanita Ave . Carmichael CA 95�r <br /> Mame AddIW Reprawnu We TYphOM <br /> 2. OPERATOR ore I 1334 2650 t . Diablo St . Stockton CA j <br /> N.m. AOdnu Tw . 1 <br /> 3. REASON FOR Regulations governing underground storage of hazardous <br /> TEST substances , subchapter 16 of chapter 3 of title 23 of the <br /> (Explain Fully) California Administration Code . <br /> 4. WHO REQUESTED Pat Wright Supervisor Circle K Corp . 5/29 /86 : <br /> TEST AND WHEN <br /> 511 Manzanita Ave . Ca <br /> "' rmichael , CA n��.wespn ( 916 ) 334-2n5 <br /> AddIW TetWnpM 3 <br /> Circle K Corporation Pat Wright , Supervisor ( 916 ) 334-2445 <br /> 5. WHO IS PAYING y or tndlvWwl etaon AUMo t TMa TetaonoM j <br /> FOR THIS TEST? `S"�'11 �ltanzanita Ave . , l!* rmicnh'1e1 , CA 95608 <br /> REIN AddrW Cliff WW Tip <br /> Attention of: Orou No. OtMI tltexuctioru <br /> Identify by Direction GpacitY Brand/Supplier Grade Approx.Ape Steel/Fibwglaes <br /> 6. TANK(S) INVOLVED ll1 10 , 000 Regular <br /> lit 8 , 000 Unleaded <br /> 113 10 , 000 Premium <br /> Mahe„ Dews Fide Vents Spltones Pumps ; <br /> 7. INSTALLATION NDR71 t <br /> DATA of S-MMZG q�YP sM� n .cr� <br /> North Inside dr"i way. Concnto.etaet Top, Sba.TiWI111 mke,Otop Conan,Remota. I <br /> Rwr M sawn,etc. Earth.eW. OrOaa.Remote Fm fka.MardicM Whwh Wnka 1 Make if mown <br /> 8. UNDERGROUND Is the waw over the»nk7 <br /> WATER Depth w the Waw table NF1 S J �vY\c P Dl`U t\ ❑ Yes No <br /> Tanks to be filled DlaCO N. PJM t1 Dau Arranged by k Name lwplwM <br /> 8. FILL-UP <br /> 'top oh w x <br /> and run TSTT. Now end who provide i Cora d. NO Lead.' <br /> Extra product w <br /> Terminal or othe,contact <br /> for muzo or inquiry IIeM 7MephOM ` <br /> ComwnY <br /> 10. CONTRACTOR, <br /> MECHANICS, <br /> any other contractor <br /> involved <br /> 11. OTHER <br /> INFORMATION —' <br /> OR REMARKS <br /> Additional inforation on any rants above.ofadvisedro <br /> is or others to be advised when testing is in pgress or comulted.Vuiwn or <br /> ocowman,Present <br /> during test ate. ��p <br /> " <br /> Tests ren nuWank <br /> de on the ow t111010716 In ew <br /> crdertce with Leet prosedtares pro"i"Abed for " <br /> 12. TEST RESULTS sedeWled on anwhed Wt rb ehewith reeuba ss b a: <br /> Tank Identification Tight Leakage Indicated Data Tested <br /> * •X32 `� tt-7 / L <br /> This M to1pm"diet th., tank systems were tested on the dMe(e)shown.Those Indicated as"Tight.Blest the odlools eoUb141ud by <br /> 13. CERTIFICATION Mw woons! Fin trrorctwn Asoc406M Pwnph* ffCRON7:1INTAL PETROLEUM ENON. <br /> LIn <br /> 3-31- 1O KL I?cb)N dlSa�l o L, <br /> Oru o esnr. ,v newt. <br /> )nlz'fZJL 777�ML=t ,'C`f� (209) 9431022 <br /> saw. Nw.No of ttxxmechnl[Wn, AadIW <br /> 6~ <br />