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5atromento Equipment Maintenance Company Inc <br /> 2533 Connie Drive Calif.Contr.License 8502377 <br /> Sacramento, CA 95815 wo 8 58602 <br /> PLEAS 9RINT 6 Data Chart for Tank System Tightness Test Stationif 5660—(696) <br /> PLEASE PRINT <br /> 1. OWNER Proparty❑ Conoco Inc. P.0.Box 69 So uel Ca . <br /> Tank(*)ElName Address Representative Telephone <br /> l (408)462-1301 <br /> Name Address Representative Telephone <br /> 2. OPERATOR Conoco 800 Hwy 12 Lodi Ca . 209 369-3124 <br /> Name Address Telephone <br /> 3. REASON FOR <br /> TEST <br /> (Explain Fully) <br /> 4. WHO REQUESTED Same AS #1 <br /> TEST AND WHEN Name This Company or Affiliation Date <br /> Address Telephone <br /> Identify by Direction Capacity Brend/Suppller Grade Approa.Ape StesI/Flberglass <br /> 5. TANK INVOLVED s r'� /O D00 �oN co SyPEP P <br /> Uta additional lints CC <br /> for manllolded tanks <br /> Location Cover Fill$ vents Siphons pumps <br /> 6. INSTALLATION SaarN cf eairet�rE )ee11;OTE <br /> DATA SroeE / lecoJACHEr <br /> North Inside driveway. Concrete,Black Top. Slza,Tllenn mak•.Drop suction.Remote. <br /> Rear of station,etc. Earth,Na tutrw,R•moU Fill$ la7ze,Manlblded Which tanks? Make M known <br /> 7. UNDERGROUNDn le tfe water over the tank? —or <br /> WATER Depth to the water table Zo(/-7&E Qp�✓�<< Ti�i� s �r.r>�No �t <br /> Tanks to bstWed 0206 hr, /"''/U Date Arranged h <br /> 8. FILL-UP Nannie Telephone <br /> ARRANGEMENTS Extra product b lop off"and run tank tester. Now and who b provide?Consider NO Leel <br /> Terminal or other contact ` <br /> for notice or lNulry <br /> Company Nam• Tat•ymona <br /> 9. CONTRACTOR, <br /> MECHANICS, <br /> any other contractor <br /> Invotved <br /> 10. OTHER r_N <br /> INFORMATION PF " <br /> OR REMARKS `r <br /> Additional Information on any hone above,Officials or otters lo be advised when testing is in progress or completed.Mason on observers pre•ars during faL wo. <br /> Tests were made on the above tank systema In accordance with test procedures prescribed for <br /> 11. TEST RESULTS as detailed on attached test charts with results as follows: <br /> Tank IdeneRcatf)ft TION Laskage Indlcaled Date Tested <br /> ESi Uf�l c5 O — —�I <br /> iS?ST _3 JI yEs f.607 Df�, -7 —9--C> <br /> 12 SENSOR 13.This Is to certify that these tank systems were tested on the date(s)shown.Those Indicated,as"Tight"meet the criteria established by <br /> CERTIFICATION the National Fire Protection Association Pamphlet 329. <br /> Technicians It Is the responsibility of the owner and/or operator of this system to immediately advise state and local authorities of any <br /> Implied hazard and the possibility of any reportable pollution to the environment as a result of the Indicated(allure of this <br /> �• ?v system.Heath Consultants Incorporated andlor SACRAMENTO EQUIPMENT MAINTENANCE COMPANY,INC.does not <br /> Sc�TES i SNCErSassume any responsibility or liability for any loss of product to the environment. <br /> p <br /> Bertai No.of Thermal roBoa§pn a `{I y 4�1 L11c_ 5 T P%T 2 —1123 <br /> e.naor /) . <br /> Grt111cadonl _�130/o?3S� Tank Owner/Operator _ DateJ—SSL <br /> 101 <br />