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Lldtd tri It IUI Id11K Jybium IIgIlt ,J Iubt <br /> PLEASE PRINT petro TitPTAN— K TESTER —_ <br /> I. OWNER Prop.ny Anco P.O. Box 5811 San Mateo, Cacti 6. 94402 Ron Wed 1-800-421-7457 <br /> Name <br /> Tank(s) <br /> Address ------_—_— Repnsenutwe T•l*phone <br /> Addreu <br /> T•Uphone <br /> 2. OPERATOR ARCO #2186, 3212 N . California/Alpine, Stockton, CA <br /> Name -- -- -- Address -- ---------- --- - ---- <br /> Tel*phone <br /> TEST - - <br /> 3. REASON FOR _ To check on . htnebb <br /> -— --(Explain Fully) _------- <br /> 4. WHO REQUESTED Ron Mitm Arco <br /> TEST AND WHEN """p,p, Box 5811 San Mateo riaCati-6ohni,a 94402 `°'"°any orARlti."n balt�e1e <br /> Address TN•Ohone <br /> S. WHO IS PAYING Ca Ron Mi Psi bame <br /> FOR THIS TEST ."y $ Y°5'g°�"p"�' San Mateo, Zi vrMa 94402 Tine Telephone <br /> aNNng Address City Sul* zip <br /> Anonlion Of:: Order No. 0"w Imtructions <br /> Identify by Direction Capacity Brand/Supplwr Grade Approx-Age Steel/Fiberglass <br /> 6. TANK(S) INVOLVED Ed oo n ? u )t✓o- lk-L tc(:L <br /> baba u A <br /> 3 -si 1 L&k-t 14'c <br /> LocationCover Fills Vents Siphons Pumps <br /> 7. INSTALLATION <br /> DATA cf l� JAj <br /> C' ft <br /> Nom kwkw driveway. Concreta.{lack Top. Size.TiWiN make.Drop Suction.Remote. <br /> Rear of su Lon.etc. Eamtc <br /> ,e . tubes.RemoN FNH Sire.Mari folded Which tank.T Make H known <br /> 8. UNDERGROUND Is the water over the tank 7 <br /> WATER Depthto the Wowtable <br /> 1:1 r« <br /> 9. FILL-UP Tanks to be filled 1L�� hr. /!� 3 �� Date Arranged by -' t ^ t C <br /> Nemo <br /> ARRANGEMENTS Exits Product to-sop off"and run TSTT. How and who to provide? Consider NO Laad. Telephone <br /> Terminal or other contact <br /> for notice or"uiry <br /> Conw•ny Nerve TNeohone <br /> 10. CONTRACTOR, <br /> MECHANICS. <br /> any other contractor <br /> involved <br /> 11. OTHER <br /> INFORMATION o", 7 f'+L OR REMARKS <br /> Additional frdoretation on any urns above.Official$or Others to be advised when testing n in <br /> during test etc. Progress or completed.Visitors or observers present <br /> Tests were Riede on IM.bow tank systems in.coordiance with tett procodLwas prescribed for ortro <br /> 12. TEST RESULTS es detailed on attached tett charts with rwuhs as IONows: 'r'irs�►s <br /> Tank sdentification Tight Lasko"Indicated Data Tested <br /> < i o - 3 - <br /> S/� <br /> 13. CERTIFICATION Thla w b cert►ry tftat thee.tank system'were tee led on the date(.)shown.Tho..Irtdlcated q"Tight"meet the criteria established by <br /> the National Fire Protection Moelatlon Pamphlet 329. <br /> //7- 3-tel✓ >,�� ,r�A,t.yc LCI <br /> Dole <br /> 414810519 <br /> Testing Convector or Company. By. Signature1-1 <br /> W No.d T <br /> Sarharmel Technicians O Box 1220 Tulare, CA 93275ns Address <br /> Sensor <br />