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1 <br />Data Chart f Tank System Tightness Test <br />.(AS( MINT r CHAMPION•',5',r,ntLCISION TANK <br />1. OWNER Property ❑ <br />Q Ne1w• AOdr•u Il•dne•nn tier 1.4a1Nw• <br />Tank(e) ' <br />N.w.. weer•., II•e.•.•wulr•• tiles'_. . <br />2. OPERATOR :2-11 <br />N. rw• Add. . <br />3, REASON FOR REGULATION GOVERNING UNDERGROUND STORAGE OF HAZARDOUS SUBSTANCES <br />TEST SUBCHAPTER 16 OF CHAI'TER 3 OF TITLE 23 OF THE CALIFORNIA ADMINISTRATIVE CODE <br />((aplsiw FVttYI <br />OWNER <br />1, WHO REOUESTEO <br />TEST AND WHEN " <br />S. WHO IS PAYING OWNER <br />FOR THIS TESTI Com"Ity. As.we. .l lnd-III.l <br />Irl.. <br />OI An.IM eon <br />Ade.... <br />O^ A..In O•.Irne <br />NO Oln•r In•1..1e t.0 ^. <br />I <br />This is to certify that these tank systema were lolled on the omiHol shown. Those indicated as —Tight" mat the criteria established by <br />13. CERTIFICATION the National Fire Protection Asotubon ramphl•t ]79 <br />fNIAIPINON'S JIM-'(,1SI.ON TANK TESTING _ <br />�u.�-- 3��1 <br />13059 CA. "- ; 13-3059 <br />--L_.✓ rr. Mir........ 1 ... . <br />Identify by Direction <br />Capacity <br />Brand/SuDplrtr G -d. <br />Appro.. Age <br />Steel/f lb.rplatl <br />, -'nom <br />TANK(S) INVOLVED <br />I <br />►nE <br />C G L XA P,t <br />1 <br />loe.lron <br />Col r <br />Fill, <br />Venl, <br />Srphon•1 <br />pum01 <br />�F4r wt <br />;. <br />INSTALLATION <br />IpQDnT <br />1 <br />DATA <br />(:Nv- <br />«enh m•.e• ere.•-.••, <br />C.wcr.l. aitch W.V. <br />S.,., lna.0 .....• Omn <br />We.l w•... o.. Idly <br />Sir.. ,,,,indole •d <br />wwrth unU r <br />MH• d awewn <br />Au1 sr NN.en, •f[ <br />lulw, •Ice <br />Is In. -.1.1 0-1 It- ten\ 1 <br />B. <br />UNDERGROUND <br />D Y•s HO <br />WATER <br />Depth to IM W-I*f tablle"�� <br />Tanks to be fined 1dJL)L1._ hl. L4 - 1 %-iA/� 1 o.1, AwanO.d by -- <br />N•rw• t •I.ehew• <br />9. <br />FILL -UP <br />ARRANGEMENTS <br />(elra product to ••top OII • and run TSTT. How and -nn to prolr•Ar I C^ns.Aer NO lead. <br />Telmrnal or other contact f.nG IJJC#,T <br />�c►� s", <br />lot notice of inquiry •� <br />COw D•n• <br />N•w.r 1•r•dwewe <br />10. <br />CONTRACTOR. <br />---- - '- <br />- <br />MECHANICS. <br />_..._...__...... _.._....__.... <br />._.^_ - <br />any othef conllsclo• <br />.. — <br />11. <br />OTHER <br />—•------..---.._....---- ..........__... _._.—__._..__.—_... <br />_ •- <br />INFORMATION <br />_ - - - _-----------= <br />-_._.-- <br />OR REMARKS--- <br />- ._._ <br />AddH10nN rnlermst.en on any Ile'n/ +hove D'i•t •all e.'p: nt.t to be ad..s•d +.rein lest.wq It In pinprett <br />_---...� __ --- <br />e1 eomptrted Vrutml a Ob/er.rera pr•tenl <br />dur.np test etc <br />Tests were made on the shove lank systems In aCCofdAncr wilt, test pr0cedvtes prescribed <br />for I'I'.TItO-TITF. <br />12. <br />TEST RESULTS <br />a+ detailed on attached test chane -11h f"11111% As 10110-2; <br />Tint IArnld.raepw l.onl leas.;• Ind.cauA.._.._._ ..._.._.._._..__—_ <br />.Date T•Ned <br />1- lr E�v(�q -__-�_.�...--•- �'I �.5.. _ : . X3.3. -... - - ---•--•--------- <br />4 � 4 <br />This is to certify that these tank systema were lolled on the omiHol shown. Those indicated as —Tight" mat the criteria established by <br />13. CERTIFICATION the National Fire Protection Asotubon ramphl•t ]79 <br />fNIAIPINON'S JIM-'(,1SI.ON TANK TESTING _ <br />�u.�-- 3��1 <br />13059 CA. "- ; 13-3059 <br />--L_.✓ rr. Mir........ 1 ... . <br />