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cadre► �r It lul IdIlK Jyataul 119int ba scat <br /> pe <br /> PLEASE PRINT TAW TESTER <br /> 1. OWNER reopen, 0 Angio P.O. Box 5811 San Mateo, Cati.6. 94402 Ron Mita 1-800-421-7457 <br /> Tenk(s) Address -- — RspresanUtiw Tafaphono <br /> Nemo Addeo" itepm"Atatiw TSUphone <br /> 1. OPERATOR ARCO #2133, 2908 Benjamin Holt Dr. /Plymouth, Stockton, CA <br /> Wmo A"fess Tolaphone <br /> 3. REASON FOR To check AoA ti.ghtne z <br /> TEST — <br /> (Explain Fully) _- <br /> 4. WHO REQUESTED Ron Mita AACO <br /> tleTEST AND WHEN " "P.O. Box 5811 San Mateo, Cati.bonn,ia 94402 `°'"°'"yaA""""°" aame� <br /> Address Tslsphone <br /> 5. WHO IS PAYING Aheo Ron Mites aame <br /> FOR THIS TEST? "°"•$'may°5'X " -' San Mateo r? Ka 94402 Ties Telephone <br /> saline Add. Cky SUM 2b <br /> Attention of: Ordw No. chhor lnstrucions <br /> behW by Direction capacity Brand/Supplier Grade Appros-Age Steel/Fiberglass <br /> 6. TANK(S) INVOLVED# oo t .o c-o (A Ao-- <br /> o 'o 00 <br /> Local' Fills Vents Sipltortea Pumps <br /> 7. DATA CATION ���5�t�� ��� r�,1, <br /> 9CD <br /> North inside tlMveway. Concf*W tlacrt Top. SiM TI IW woks,Drop SuctbkenN,Mmote.w <br /> Rsor M s"004%s"004%oft. Earth.etc. tubes.RerwMe felt Sirs.MOMfofoed Winch tanks) Maknon <br /> 8. UNDERGROUND Is the water ober the tank 7 <br /> WATER Depth to the water table r7 •, <br /> Yea <br /> 9. FILL-UP Tanks to be fined &' Date Arranged by <br /> TNaphons <br /> ARRANGEMENTS Extra product woff-"wp o "and run TSTT. Now and Who to provide 7 consider No Land. Nof a <br /> Terminal or other contact <br /> for nobos or inquiry <br /> Co"Wany lh r 7s+tsphons <br /> 10. CONTRACTOR, <br /> MECHANICS. <br /> anW other contractor <br /> involved <br /> 11. OTHER <br /> INFORMATION 15 k3 LV_- <br /> cA. Ta <br /> OR REMARKS <br /> AddrtrtMal infatuation ort any hertts above.Ofliciak or otlwn b be advised when testing is in progress or compieted.Visitors or observers present <br /> during test etc. <br /> i <br /> Testa were made on the above tank systems in accordance with test Procedures Prescribed for p��p� <br /> 12. TEST RESULTS me detdbd on attached test charts with moufts as follows: P— <br /> Tank Identification Tight Leakage Indicated Date Tested — <br /> VAI /( -76 -1 <br /> 13. CERTIFICATION �is Io W��s tank�wery Nsted on the date(.)shown.Tfaes ktdleated as-ngw mast the erlterla estab"hed by <br /> .nWhfet 329. <br /> Dote LCI <br /> Testing Contactor or Company. ignetu e <br /> 414810519 P. O. Box 1 O Tularar CA <br /> SerW NO.or Thermal TocMNcians -- Adtlrost <br /> Sensor <br />