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r.. <br />�IIIII�� Champion <br />Precision Tank Testing <br />License No. 73848 <br />Date: 7-(3l <br />Site ID: MOUSS <br />Operator. F Si— <br />Site Address: Q3— •kid 7�,7—� <br />City: �% Q Slate: <br />Zip: q�532 te Phone: <br />System Type: Pressure <br />Piping: Steel <br />Secondary Containment <br />Pump Operating Presses <br />Line Isolation Method: ) <br />Test Start Time: C c <br />.i <br />P.O. Box 13059 <br />Sacramento CA 95813-3059 <br />CA 800-660-9443 <br />NV 800-949-9443 <br />1-916-927-1557 <br />Fax: (916) 927-7345 <br />Petro - Tito Precision Line zest <br />❑ Type Suction 0 Type h!�e�LV <br />Fiberglass ❑ Other: <br />Yes ❑ No 9 Leak Defector Yes ❑ No <br />ISO% Test Pressure I P <br />Comments: <br />Comments: <br />TECHNICIAN: William Campbell - LIC. 90-1324 -SIGNATURE- i - Dete:D-70-0 <br />