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CRISP TANK TESTING OWNER OF SITE <br /> r <br /> 2004 Piccoli Rd. #9 <br /> 1,-)- <br /> Stockton, CA ADDRESS <br /> _ <br /> WORKSHEET - CITY-STATE-ZIP CODE <br /> ENVIROMENTAL HEALTH l� <br /> FERMIT/SERVICES, <br /> f OWNER OF TANKS <br /> TANK No. ! / TEST LEVEL !? U I'I I F'� <br /> I , PRODUCT � - CAPACITY �? •,,� CHART CAL _ � © ., 9/4 �_. (A) <br /> MEASURED GRAVITYPRODUCT TEMP "f COEFFICIENT `' '{ = TEMP CAL+ /D(oa. ' � ' � IB) ADDRESS <br /> Air Temp <br /> TEST LEVEL LEVEL GAIN+ x(A) LEVEL TEMP. TEMP. GAIN+ x(B) TEMP. FINAL CITY-STATE-ZIP CODE <br /> NO. START END LOSS— X(A) RESULT START END LOSS— x(e) RESULT RESULT TIME <br /> OPERATORS NAME AT SITE <br /> 1 X X c TYPE OF SYSTEM <br /> ❑SUBMERGE !'SUCTION <br /> ---_ --- �—�—_ f + /` ' — • , 1. i r� r _ �1 I LENGTH OF COLOR CODE OF PRODU <br /> FILL PIPE <br /> CLEAR ORANG <br /> RED <br /> jt f�t�e e 7 •-1 l } J1 - � * 'r DIAMETER OF TANK <br /> • �J ) ❑ METAL <br /> s ► )( s 1 — s X � 6 �� ❑ FIBERGLA <br /> _ _ s c <br /> . D U (; TYPE OF RECOVERY SYSTEM <br /> I ` MBALANCE ❑ REDJACKET ❑MEAL <br /> -, — _ — r .. <br /> J / X (� 1 <br /> J '. Q I!� s /i/� / F / ,� J G d. '� �'� 7 t� / WATER LEVEL IN TANK <br /> Liquid level <br /> � r <br /> L4 X <br /> . o � I6� . L' .. . �_> I ,,z 7., a �� -) <br /> DEPTH OF GROUND WATER (IF KNOWN) <br /> DATE/TIME STORAGE SYSTEM FILLED <br /> DATE TIME <br /> STATION LOCATION `' �' I' CERTIFIED TIGHT <br /> I AGE OF TANKS <br /> ADDRESS �/ <br /> i LEAK RATE PER HOUR <br /> i,E i r OPERATOR �. l -� �� �'' S - <br /> - AGE OF LINES _�;•.' <br /> PATE r L _p SIGNATURE r r) •,L► <br /> f Q TESTING FLUID,IF DIFFERENT THAN <br /> n%Irn rnr+ nr-..S.-•r STORED MATERIAL <br />