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OIL EQUIPMENT SERVICE STATE LICENSE No.323417 <br /> CLASSIFICATION: A-HAZ., C61D40 <br /> Division of Keith A. Tallia, Inc. STATE ENVIRONMENTAL ASSESSOR No.01781 <br /> Telephone: (209)754-1808 <br /> Fax: (209)754-5726 <br /> Post Office Box 950 <br /> 750 Industrial Way <br /> SAN ANDREAS, CALIFORNIA 95249 <br /> Property <br /> Owner : S7'DCK7'0 N: PC L i <br /> Address : ti FL N�L *`<_K7�ti C.a, 45 tea : <br /> Tank Address : <br /> *Notice to owmer(s)* A copy of this test result has been filed with the proper regulatory <br /> agency. It is the responsibility of the owner(s) to contact the local Env. Health Dept. in <br /> his or her area of any tank failure within (24) hours of testing. <br /> Tank; Product Capacity Apx . Age Steel Fiberglass Supplier <br /> S�L uNL-A G(A,LL—,A-DED <br /> Tank( s ) were filled on : 5,-4n Distributor : C,/-. � y_ v4n�T <br /> Date Time <br /> Extra product to top off :_NoV;, Yes [ ] Gallons - <br /> Comments : <br /> TEST RESULTS INCLUDE <br /> Tank( s )_L--' Product Line ( s ) ✓ Vapor Recovery System Vent Line ( s ) y <br /> Tank Tight Tight Leak indicated Leak indicated Date of <br /> IDS Tank( s ) Line( 2 ) per hr. ( tank ) per hr . ( line ) testing <br /> u11L=A-DZ-i) Yes No( ]Ye s.Wo [ ] + . 00;7 C. <br /> Yes [,]"No( ]Yes 9No [ ] — . O <br /> Yes [ ]No[ ]Yes [ ]No[ ] _ <br /> Yes [ ]No[ ]Yes [ ]No [ ] <br /> Yes [ ]No[ ]Yes [ ]No[ ] <br /> Yes [ ]No[ ]Yes [ ]No [ ] <br /> Technician : /°��K ���C�l�2 � License "r : 4?�EL `/V07 Date : -Z--.o- QS <br />