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uaia wnan iur janK system j Ignmess jest <br />petro TttP <br />PLEASE PRINT <br />1 <br />TANK TESTER <br />Vents <br />Sephones <br />Pumps <br />1. <br />OWNER proQerty <br />AiLco P.O. Box 5811 <br />San Mateo, Cati 6. 94402 <br />Ron M.i.ie.e 1-800-421-7457 <br />c� D <br />Tank(s) <br />Nam. - - _. -- <br />---- Address ------- <br />_--- -----Repgsenlehw <br />-- <br />North Inside driveway. <br />Rear of sts"em etc. <br />Concrete. Black Top. <br />Earth. etc <br />_ <br />Which tanks T <br />SM uori.k. d len .I , <br />8. UNDERGROUND <br />Telephone <br />Address <br />_Rpresenleuw __ --- <br />T.Nphene <br />2. <br />OPERATOR <br />_ARLD_b1Q0 25775-S. <br />N.m. y- <br />-Par�on -Pass_ <br />/Hwy. 5, <br />Tracey, CA <br />_Rd. <br />AAdr.st <br />- <br />_ <br />3. <br />REASON FOR <br />To check _Joh�h.tneaz <br />Teleonone <br />TEST <br />- — -- - <br />- <br />- <br />----_--- <br />(Explain Fully) <br />4. <br />WHO REQUESTED <br />Ron M,i-im <br />Ahca <br />TEST ANO WHEN <br />"a"'p 0 Box 5811 San <br />Mateo,`"•CaPc ohL is 94402`""°•"`aA"""a°n <br />Dale <br />15_ <br />same <br />'eco <br />Address <br />5. <br />WHO IS PAYING <br />Ron MkIm <br />FOR THIS TESTI <br />PV'y$�'o5'$d1'p'"' San Mateo, 9t1i°ia <br />94402 <br />T"" <br />flame <br />T.l.°^°^• <br />Bitting Address <br />City <br />St." <br />--- <br />Zip <br />AneMion of: <br />Order No. <br />01h.r Instructions <br />Steal/Fiberglass <br />6. TANK(S) INVOLVED <br />Identify Dinetion <br />W t S <br />Capacity <br />C^• o n <br />Brand/Supp liar <br />ti �.Su li1L <br />Grade <br />g �L to Q t� r_ <br />Approa. Aqe <br />^ <br />t e vlel_ <br />C,C,r <br />«,nAI <br />L�IvCL-4nG <br />5t7e� <br />7 <br />DCIJ <br />y/ <br />L <br />4, c r <br />e <br />�+ <br />N YYI (11(_�r <br />. <br />s <br />t <br />(e- <br />-- ��� <br />Li &- (/J`/L <br />J <br />' c: Ws <br />Location <br />Cover <br />Fiik <br />7. INSTALLATION <br />1 <br />Z � 7c <br />Vents <br />Sephones <br />Pumps <br />DATA <br />`S S ,�E <br />Cin ��f <br />L 1 <br />c� D <br />Zit <br />I(1 70� <br />�� <br />/L c- <br />North Inside driveway. <br />Rear of sts"em etc. <br />Concrete. Black Top. <br />Earth. etc <br />Size. Tltefill make. Drop <br />lubes, Remote Fists Size, Mandolded <br />Which tanks T <br />SM uori.k. d len .I , <br />8. UNDERGROUND <br />WATER <br />Is the water over the tank 7 <br />Depen to the wet.. table <br />-_ n <br />❑ res <br />� No <br />9. FILL -UP Tanks to b. rifled ? hr. /i� ?' ST Date Arranged by L-1 N 1 1 � ,' I ^ S /. �'1 Cf <br />Na""- Telephone <br />ARRANGEMENTS Extra product to "top off" and run TSTT. Now and who to provide 7 Consider NO Lead. <br />Terminal or other contact --- <br />lot notice or inquiry <br />Company Name - <br />Telaphon. <br />10. CONTRACTOR, <br />MECHANICS, <br />any other contractor <br />involved <br />11. OTHER <br />INFORMATION <br />OR REMARKS <br />renter rarameuon on any Items above. Otfleials w others to be advised when testing is In progress or completed. Visitors or observers present <br />during lest etc. <br />12. TEST RESULTS -,ewer.. n, ecWrwrtp wren test procedures prescribed for orfro <br />as detalled on attached test charts with results as follows: '�•`h� <br />Tank Identification Tight Leakage Indicated Date Tested <br />sly �S/ r f i h� 1 (C - - -- <br />a E^ <br />r L f1 � �7r Al LIL' <br />kk <br />13. CERTIFICATION Tt><a 10 °efts a'at ales- tar'i` systems tarere tested on the dates) shown. Those Indicated as "Tight" "sect the a1 established by <br />Ithe�lNatiwsal Flre %Protection Asoclation Pamphlet 329. <br />LC I <br />_ <br />Tstmg Contuaor o. Company. Br rg nature --- <br />9 P. 0. Box 1220, Tulare, CA 93275 <br />Seryl No. d TTtennal T«nnrcrans / - <br />