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Sacramento Equipment Maintenance Company Inc, <br /> 2533 Connie Drive Calif.Contra License 5502377 <br /> Sacramento, CA 95815 Wo 5 58217 <br /> (916) 925-2716 <br /> PLEASE PRINT Data Chart for Tank System Tightness Test Stations 1/494 <br /> 1. OWNER Rw v❑ 466 Hanford , CA 93232 Ju1iQ Caldwell <br /> Tankm❑ Nan" Address Repreesntative <br /> Nam. Address (209)T <br /> -0241 <br /> Rowseenbt <br /> Tdepthor" r <br /> 2 OPERATOR Beacon 2185 Fremont Stockton, CA (209)465-1551 <br /> Address Telephone <br /> 3. REASON FOR <br /> TESTCount permits <br /> (Explain Felty) r'-.. ,.. _ .... <br /> 4. WHO REOUESTED ) , <br /> TEST AND WHEN "'"" Tels cA^wnyor <br /> Address Telephone <br /> Identify by Dk.cson Capacity Bfwx15upplw Cede MfpnxL Steet/FlI"rgtass <br /> 5. TANKINVOLVED _ , -- .•;.j <br /> Ufa additional rnn ,311r,* 494-2 Z <br /> for marhNddsd tanks .:T4 C j r,6� 10,000 494-3 Premium 1966 <br /> Location Cover Fels - Vents <br /> 8. INSTALLATION umps <br /> 406r QF uW y �� / <br /> DATA <br /> North Inside*%*way. 9"dc T Sys.TWO mak..Drop suction,Rrrwts, <br /> ROM of ddlmk etc. k6es.Remote rills Sin.MenHotded which tanks? Make If known <br /> 7. UNDERGROUND b the wafer over the tank? <br /> WATER Depth to the W&W baa {�1 <br /> ❑Yee e7LNo <br /> 8. FILL-UP Tanks to be Need hr. °°e "^rhged by <br /> Name Telephone <br /> ARRANGEMENTS Extra product to lop ofr and nm trot fader. Now hod who fo provide?Consider NO Lead. <br /> Terminal or Darer contact <br /> for notice or Inehtry <br /> Company Name Telephone <br /> 9. CONTRACTOR, <br /> MECHANICS, <br /> any other contractor <br /> Involved <br /> 10. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> Additional information on arty hems above.ONlcab of others b be advised when ladkhg Is In progress or oomp"ted.Visitors or observers preset during ted,at, <br /> i <br /> 11. TEST RESULTS Tests were made on the above tank systems In accordance with test procedures prescribed for <br /> as detailed on attached test charts with results as follows: <br /> Tank kfentlfic tics Tight leakage kmscow Date Tested <br /> 494-1 reaular X <br /> 494-2 unleaded <br /> 1 ; • <br /> 12- SENSOR 13.This Is to cer0ty that these tank systema were tested on ted dates)shown.Those Indicated as"Tight"meet the criteria established by <br /> CERTIFICATION the National Fire Protection Association Pamphlet 329. <br /> r TeclwtcYne it is the responsibility of the owner and/or operator of this system to immediately advise state and local authorities of any <br /> Dateimplied hazard and the possibility of any reportable pollution to the environment as a result of the indicated failure of this <br /> 1U� • system.Heath Consultants Incorporated and/or SACRAMENTO EQUIPMENT MAINTENANCE COMPANY.INC.does not <br /> — `5� .assume any responsibility or liability for any loss of product to the environment <br /> - <br /> Be"neNo.of Tharmal Grs§(;@tW• V 5r akt0 ae-.93-13 - <br /> Sensor <br /> LQrsaaRciJL <br /> �acL� <br /> certiacatlon1 Tank er/ .� <br /> Date <br /> 101 <br /> Afl �-�....x.l�a,�S•:.awlt4Y6+,� ..4Yl Jt'e..MY S '; <br />