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CRISP TANK TESTING OWNER OF SITE <br /> 2004 Piccoli Rd. #9 <br /> Stockton, CA 95205 � •`' r-� r `� �� ADDRESS <br /> , I HORNER EASY TESTING METHOD ) <br /> MAR 1 X88 -. 0 i . - <br /> WORK SHEET <br /> � 36 CITY•STATE-ZIP CODE <br /> ENVIROMENTAL HEALTH <br /> FERMIT/SERVICES, <br /> r <br /> OWNER OF TANKIk <br /> TANK No. )t TEST LEVEL PRODUCT10 CAPACITY ICHARTCAL <br /> J <br /> 5A-7-1 17-1 <br /> I <br /> MEASURED GRAVITY— 5�? ,7 PR OTMP ' COEFFICIENT TEMP CAL 00D' , a 75B ADDRESS <br /> Airemp <br /> � <br /> TEST LEVEL LEVEL GAIN• x(A) LEVEL TEMP. TEMP. GAIN♦ x(8) TEMP. FINAL CITY•STATE-ZIP CODE <br /> NO. START END DOSS— x(A) RESULT START END LOSS— x(e) RESULT RESULT TIME <br /> . ` �� Q / D i �- Q0 r X� s ` !-v �; OPERATORS NAME AT SITE <br /> U L) <br /> X s r — / X = TYPE OF SYSTEM <br /> 00 73A �Q <br /> ❑SUBMERGEUCT�ION <br /> S <br /> X c c 'f LENGTH OF COLOR CODE OF PRODU( <br /> o0 T �i J.� O ! J� � � i FILL PIPE <br /> _ CLEAR ORANG <br /> s X — X L ?7/!o� RED <br /> DIAMETER OF TANK <br /> �ETAL <br /> t) <br /> _ I l ❑ FIBERGLA <br /> s X � _ s ,Y s c <br /> j TYPE OF RECOVERY SYSTEM <br /> BALANCE ❑ P.ED JACKET ❑HF-4L., <br /> X _ X <br /> WATER LEVEL IN TANKI Liquid level <br /> DEPTH OF GROUNDWATER (IF KNOWN) <br /> I _ <br /> X s — X <br /> DATE/TIME STORAGE SYSTEM FILLED <br /> F✓� i DATE TIME <br /> i STATION LOCATION / l I ✓� l �GI''L� CERTIFIED TIGHT�/I!" 2; =j —9 <br /> CI AGE OF TANKS <br /> ADDRESS I �--► + �- LEAK RATE PER HOUR�i�� �^ <br /> CI T Y <br /> STAT OPERATOR <br /> AGE OF LINES <br /> DATE =� ''x� yt- : �' ` (�+..t-cL� <br /> 7 � � SIGNATURE � �� <br /> 1 TESTING FLUID,IF DIFFERENT THAN <br /> (1VGR 9:f1g gC'.AnNr STORED MATERIAL <br />