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i <br /> Horner CHAMPION <br /> TANK CERTIFICATION ron Tank Test:ng <br /> 1,59 <br /> kak detector 1: REPORT Seaamento,CA 9'513-3059 <br /> OVif1VERS Property Q� f�M LCskug—S7 <br /> knowTtwone <br /> NAME Tankis► <br /> eowtu Ga w <br /> A=s -=2a!-cS r j-111 <br /> NAME OF tame t <br /> LOCATION 0:3Z;-O K4< 1 v t>, R a C 9 S 3`7� <br /> a ter zo <br /> NOTICE TO OWNER A copy of aN test results have been fled with the proper reguiatory agency governing underground <br /> storage systems. Yes 0 No 0 if not Ned. ace explanation below. <br /> RECORD OF <br /> FILING <br /> Location of agency where filed: <br /> REASON FOR <br /> TEST <br /> (Explain Ft yr) NOTICE It a the 0w1w$ reoponsbiltyto contact the__ h_" of any failures with 24 hrs.of the resilUs <br /> pawn to the ownw. <br /> WHO REQUESTED watt OWN <br /> TEST AND WHEN? Ad*rw <br /> tp Oeacaan Captary &Mk0/Sappy Graf Appoa•Ape am r F m wpw <br /> of o■nr�a (d"nownl <br /> ITEM ORSYS7EM TESTED <br /> TANK ONLY ❑ ❑ <br /> Pi{07JCT LINE <br /> W,97-NE Er ❑ o <br /> YAPOR UNE 0 ❑ ❑ <br /> ALL OF THE ABOVE 0 ❑ ❑ <br /> Taws a be Mod � S 3 O <br /> FILL-UP 7`a/-j 0,(e-- <br /> ARRANGEMENTS <br /> C'LARRANGEMENTS ►+�" <br /> Eos ptodua a-op air YES C <br /> OTHER <br /> INFORMATION <br /> OR REMARKS <br /> Addkthonal sntorsnatOn on ACT'"MG.Cove.OM C Mt M O"W$b be aOwb 011Nt WIN n m prograas or eonpwW v"wws or oowve+a prosom&.Omg <br /> "I tic <br /> Ttk"N waw M&SO to do,aoow Wra tgaMw in low IM t`ZYY Chock Leek ooltdae NO <br /> TEST RESULTS precedweeFn..tne.r <br /> TWAt Tqa Tana T 6resa Lte"r®&.softws Trot Lewswas <br /> re sacred Lrt/ Ore Teed <br /> kmeaow <br /> TANKS E7' v« 00'w O •.. O'No (3 ,2. <br /> PRODUCT LINES er, vee O "a O Yea 0 "b O <br /> 6 Vent Yes al-*� was O w O vw O No O <br /> LOW Mcluded No 0 vee O wo O rw O Ne 0 <br /> its O No O vw O No G <br /> TION This is to ogejfy eat Vow tank wereI I an the t NWs) sh wn. Those Indicated as'Tidkt'wast the Criteria astablialted by <br /> CERTrICA <br /> the National Fire Protection Associabo I'mWilat 329). <br /> ��—qz Technicians: <br />