Laserfiche WebLink
IIII IIII Champion P 0. Box 13059 <br /> I i Preclslon Tank Testing Sa amenlo, CA 95813.3059 <br /> 1.Icen" No. 73848 CA 800-660-9443 <br /> NEV 800-949-9443 <br /> (916) 927.1557 <br /> Fax: (916) 927-7345 <br /> HORNER EZY-CHECK CERTIFICATION <br /> Owners Property Tanks(s)_ <br /> Company C;i, <br /> Address s " c / Phone-(__j <br /> City State Zip <br /> Name & Location of Company <br /> Company B 1 C/ S- , Q,T— Phone_( _) <br /> Address SZ Ti / d <br /> City 7 o v n p State Zip <br /> NOTICE TO OVJNER(S)l A COPY OF THIS TEST RESULT HAS BEEN FILED WITH THE PROPER REGULATORY AGENCY, <br /> WHICH IS REASON FOR TESTING <br /> 'NOTICE'IT IS THE RESPONSIBILJ7Y OF THE OWNER(S)TO CONTACT THE LOCAL ENV. HEALTH DEPT., IN <br /> His/HER AREA OF ANY TANK FAILURES NTH(24)HOURS. <br /> Who requested When? <br /> Identify by I.D Product Capacity Apx. Age Steel Fiberglass Brand/Supplier <br /> --�-------- GSA----- 5 o.�a v <br /> Tanks to be filled Date: 5 - i - g 6 Time- /Soo <br /> Distributor Extra Product to top off -S A i <br /> Comments 84, j Z�c@P �J ., s a.g P2 L4 I- inzA- <br /> REPPESENTAT,VE(S)OR OVJNER(S)M L BE NOTIFIED I':'{N THE TEST HAS BEEN COMPLETED AND ONE OFFICIAL MUST BE PRESENT DURING <br /> THE TESTING. ALL TESTS MADE ON THE TANK(S)SYSTEMS ARE VALID THE HORNER-EZY CHEK LEAK DETECTION PROCEDURES. <br /> THIS CERTIFICATION SHOWS THE CRITERIA ESTABLISHED BY THE NATIONAL <br /> FIRE Assoc.{PHAMPLET 329). <br /> Test Results Include Tank(s) L'� Line(s) ff Va or Recovery System C9'`/ent Lines) <br /> Tank Tight Tight Leak/Per Hr. Leak/Per Hr. Date Tested <br /> ID# Tank Lines Ind. Tank Detected Line <br /> / Y ❑ YEN ❑ t- <br /> YRN ❑ Y2-N ❑ + _ <br /> Y ❑ N ❑ Y ❑ N ❑ <br /> Y ❑ N ❑ Y ❑ N ❑ <br /> Technician: /Au / /�,,,d Certification #: <br />