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�6v go 9l Data Chart for Tank System Tightness Test <br /> petro Tile PAYMENT <br /> HNk TESTER <br /> PLEASE PRINT <br /> ?. OWNER Property ❑ _.---- twpnono <br /> Name <br /> Apdrp. bpro•nutivs <br /> Tanks) ❑ B•prw 1 Tal•pnp.. <br /> Neme AddrW <br /> 2. OPERATOR GSdKGi Y411lG - Monroding St ckt n <br /> Nome Addr.ee <br /> 3, REASON FOR jefou/ try <br /> TEST <br /> (Espuin Fully) <br /> 4. WHO REQUESTED G <br /> Neme Till, Company or ABiWM •fe <br /> TEST AND WHEN S'r*Ckr_Al IC ` 499 1 �fJ' 7 <br /> Add ms Telephone <br /> 5. WHO IS PAYING Cabe Salla (209 )477-7563 <br /> FOR THIS TEST? `3�t9r'to `vRotii"rihood P•r`°nA"'tTn8ckton CA 9520Te T•I•onpna <br /> Bunny Addav, Cm' sur. zip <br /> Auemion ot: order No Other In«mcb°ns <br /> Identify by Direction Capacity Bund/Supplier Guide :Appm .Age Stee4Fibergiess <br /> 6. TANK(S) INVOLVED �.�y74L evi ff L <br /> #--r: c= d Z4__ <br /> Location Cover Fills Veno Siphons, Pumps <br /> 7. INSTALLATIONr <br /> DATA C1 <br /> NorthInside driveway. Concrete.Bueifiu Black Top. Size.Tmake.Drop Suction.R•mou. <br /> Pi of.tenon.eta bnh.M. .be, flamole Ful. Six..M.nlluld.d Which nn"t M•k•it enown <br /> B. UNDERGROUND Is the water w,,the tankT <br /> WATER Depth to the Water staablle R�LGf� Til Al D} iM 11yes �j No <br /> Tank,to be filled M-0 hr.I Data Arranged by DOM TheX LL A <br /> 9. FILL-UP Nom. T.leohone <br /> ARRANGEMENTS Extra product to"top off"and run TSTT. How and who to provide 7 Consider NO Lead. <br /> Terminal or other contact <br /> for notice or inquiry <br /> Company Nem• Teupnon. <br /> 10. CONTRACTOR, <br /> MECHANICS, <br /> any other Contractor - <br /> involv.e <br /> 11. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> rduring <br /> inlormation on any items above.Officials or others to W advised when testing is in progro.s or completed.Visitors or observe•,pu.•m <br /> t ate. <br /> re moos on ted abow tank systems In aeeArdance with test proceduraa prescribes for Mire>�P12. TEST RESULTS as duelled on Ntaehed test Charts with results a tollowsag-'fr�tification Tight Lookape ledicat•d Dat.Tested <br /> P <br /> This Is to esetl/y that""Yak systems welt Wted an MN dste(s)Pnewn.Those Mtdlosted pmeet red pdd*~aT <br /> 13. CERTIFICATION the National Fire Protection Aaoolabon Pamphlet OTt. <br /> NORTH CAI CONSIRLICTION <br /> ___._ Deu -- __ - _ _ •e ctol m omMnr / ruun <br /> 51 of kion,r- 2(11 <br /> 4w Ns. a Tiwmv -_ —T«nn¢wn. - Assess <br /> Besw <br /> t <br />