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4 - <br /> HORNER EZY-CHEK TANK CERTIFICATION REPORT <br /> Champion Precision Tank Testing (916) 927-1 (800) 9443 <br /> License 473848 ( ) 949-9443 Nv. <br /> Owners (3 Property ;7an`kkws(s) <br /> Company! _ <br /> _�gAjc <br /> ............Phone- <br /> ompany! __________--Phone_t____? <br /> ---------------- <br /> Address! .���_4p 2------------------ <br /> C1 ty°_YLA51�ti`>� State:__r _eZ1 P <br /> ----------------------------------------------------------------- <br /> Name & Location of Company! <br /> Company° _ Phone!_(�off) . <br /> Address: <br /> - ---------------------- <br /> ______ <br /> city!---tA654. -------------------State!___eA------ai P !--q5-37h <br /> Notice to Owner ($) l A copy of this test result has been filed <br /> with the Proper Regulatory Agency. Which isl_____________________ <br /> Reasonfor Testing !---------------------------------------------- <br /> Notice! It is the responsibility of the owner to contact the Env. <br /> Health Dept. of any failure on tank (s) within (24) hours. <br /> Who Requested & When?!-------------------------------------- <br /> _�___ _____ _-®__��N�—___Date!_-______ <br /> 011ank Onl y> roduct Li ne vent Line Q Vapor Li neQ Al l of these <br /> Identify ! Capacity ! Brand ! Grade! Age! Steel ! Fiberglass <br /> by ID# ! !Supplier ! ! ! ! <br /> ----------!--------l _!____l__— _!______________ <br /> !--------! !____!_-!�__.!-------------- <br /> -----------;----------1--------1------l----l------ 1-------------- <br /> -----------l----------l--------l------!__®_l------l-------------- <br /> -----------l----------l--------l------l----l------1-------------- <br /> Tanks to be filled ! Date!-a-j'7-7 3 __Time! 16o� <br /> Distributor !_Xptti;i7g� _gap _ <br /> c. Extra product to top off !__41-Q________ <br /> Comments!--------------------------------------------- <br /> ----------------------------------------------------------------- <br /> 7 <br /> -------------- -------------------------------------------------- <br /> Representivetsor owners will be notified when the test is <br /> completed and one official must be present during the testing. <br /> All tests made on the tank (s) systems are valid with the Horner- <br /> Ezy Chek leak detection procedures. This certification shows the <br /> criteria established by the National Fire Assoc. (Phamplet 329). <br /> ---------------------------------------------------------------- <br /> Test Results Tanks, Product Lines, Vent, V Inc. )(jjP No <br /> Tank Tight Tight Leak/Per Hr Leak/Per Hr. Date <br /> ID# ! Tank ! Lines ! Ind.Tank ! Detected LinelTesting <br /> l----------l- _----- °--------------l-------- <br /> _ ° ___ _ ° _________-__ <br /> V <br /> °-------- _ <br /> Y 0 N Ol YO N Ol-------------1--------------1-------- <br /> Y 0 N01 YO N01------------- --------------I----- -- <br /> I <br /> Ql-------------1--------------1-------- <br /> ! Y 0 N01 YO N01------------- --------------I-------- <br />