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CRISP TANK TESTIN <br /> 2004 PICColi #9• <br /> Stockton, Ca 95205 (209)931.1828 <br /> TEST REPORT NOV 2 9 1190839 <br /> V <br /> OWNER OF SITER,-C',,rr_UTAL HEALTII <br /> ' <br /> ADDRESS / A, ; 0 1' CITY STATE CJ. ZIPS <br /> OWNER OF TANKS <br /> ADDRESS CITY STATE ZIP <br /> OPERATOR AT LOCATIONS U�' � � o r b V � r ,-� <br /> ADDRESS-/ P% /- L R /i) J / CITY��nC �' <br /> f fv STATEZIP'T�,r%z,5 <br /> NAME OF COU14TY > »,j r) <br /> TANK , e ON PLOT PLAN. AGE OF TANK <br /> DESCRIPTION OF TANK: <br /> CAPACITY_/ GQ () ,DIAMETER_ 1�, METAL_ FIBERGLASS <br /> TYPE OF SYSTEM: SUCTION`: SUBMERSIBLE OTHER <br /> VAPOR RECOVERY SYSTEM? ; TYPE <br /> PRODUCT BEING TESTED c (��- ,a MEASURED GRAVITY_ <br /> API SPECIEIC GRAVITY 9 60°F P.L0 <br /> STORAGEST <br /> L��1: _ <br /> L _ DATE 1 c.l,�. (i�! , TIME / y(�J . <br /> TESTED - DATE ' j 1-1 , STARTO O , FINISH <br /> LENGTH OF TEST 2 <br /> MEASURED WATER IN TANK HEIGHT OF LIQUID LEVEL 0 <br /> DEPTH OF GROUND WATER— /J PSI AT TANK BOTTOM__ <br /> RESULTS OF TEST: <br /> CERTIFIED TIGHT? - YES ;✓ ; NO IF NO EXPLAIN IN REMARKS. <br /> LEAK RATE PER HOUR: + ; or <br /> REMARKS BY OPERATOR <br /> NAME OF OPERATOR <br /> SIGNATURE OF OPERATOR <br /> DATE <br />