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CRISP TANK TESTIVIG (:C�PJ C() . <br /> P.O. DOX 30407 LICENSED <br /> SUICKION, CA 95213 INSURED <br /> Q09) 931- 1020 <br /> FAX (209) 465-30116 <br /> LICENSE <br /> * ** * *TEST RL'PORP * ** LE01',1ARD 1. <br /> OWNER OF SI'I'F.:lf-kez <br /> CITY:_f9C_jt -- <br /> OWNER OF <br /> AI)DRFSS:_.�-------------------- CITY:---- -- -----------, <br /> OPERATOR AT' LOCATION:-.h---1 a.1� <br /> La — ZIP:AIS' .c)6--- <br /> COUNTY:-��E�r1rZ-H 2S1��---- T'ANK#:PI'Lf, AGE:-AIL <br /> METAL(YC) FIBIiRGI,ASS( ) SINGLE. WALLED( DOUBLE WALLED( ) <br /> DIF,SFI.( ) UNLEADED ( ) PREMIUM UNI.. ('y4 <br /> SIJCTION('-(J SIJBMF,RSIBLF.( ) OVERSPILI. CONI'AfNFR*`YFS( ) NO(>c) <br /> SHEAR VALVE:"YES( ) NO(�4 1N-LINE LEAK DE-rECT'OR"YES( ) NOOc) <br /> VAPOR RECOVFRY SYSTEM'"YES(K) NO( ) IF YES, PHASE [(-�) PHASE II(/,O. <br /> TANK FILL <br /> TANK TEST DATE: -11 ST'AR'I':01�14--__ �Q— <br /> LENGTH OF Tr:ST:_R__- lZ s __ <br /> TANK BOTTOM TO GRADE..... TEST LEVF,I, 7'0 I'ANK BOTT-OM....Li __ <br /> TANK TOP 1'0 GRADE............_ " GROUND WATER ABOVE TANK....._-P_-___" <br /> D I A M E'rF,R.:...........................__`� '-_" PSI <br /> T'FST LEVEL ABOVE GROUND._?,�_- _" NET 'I'F.ST PRESSURE..... <br /> WA .................. <br /> TER IN TANK.................... -- API SPECIFIC GRAVITY................ . <br /> DEPTH FOR TAKING SAMPLE...-O-10-2 TF,MPF,RATURE................................ �_-- <br /> T'EMPF,RA'rURE PROBE DEPTH....3 1 API SPECIFIC GRAVITYrp 60' F...... <br /> COFFFICI FNT OF F,XP....................... <br /> LEAK RATE PER/IIR:+--Ol <br /> CERTIFIED TIGHT: YES( NO( ) <br /> I'lWDUC'1' LINE, '1 I;S'1': SUCTION0�0 PRESSURE( ) <br /> LEAK RATE PER/IIR: �__�._/- 61 <br /> CF,RTIFIED T'iGwr: Yl'-,SN) NO( ) <br /> SIGNATURE. OF TFSTE <br /> C O M M F.N T'S:-------.-----__ <br />