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Data Ch* for Tank System Tightros Test <br /> CHAMPION'S PRECISION TANK TES=G <br /> PLEASE PRINT <br /> 1. OWNER Property ❑ RMC/Lo"nestar industries 0.0. Box 52�2 Pleasanton, Ca. 94566 <br /> Tank(s) BrAT"Stately 415-426-2211MI-1-110 Tifteohone <br /> Name Address Re0re4enta nae Telephone <br /> 2. OPERATOR Km-nm f7 C ]1A <br /> Name Aod,ferie, T.�ephonrt <br /> 3. REASON FOR REGULATION GOVERNING UNDERGROUND STORAGE OF T)OTIS, SIRSTANCEE,'l— <br /> TEST SUBCHAPTER 16 OF CHASTER 3 OF TITLE 23 OF THE CALIFORNIA ADMINISTRATIVE CODE <br /> (Explain Fully) <br /> 4. WHO REQUESTED aWER <br /> TEST AND WHEN Narn. Tire, Company o,AM14%­ Data <br /> Address Telephone <br /> 5. WHO IS PAYING OWNER <br /> FOR THIS TEST? Company.Agency or Persor,Authorizing Title Telephone <br /> Billing AOC,- CII, state Z.0 <br /> ATIeni,on of O,de,No Other Instwo'.ne, <br /> Identity by Direction Capac,ly Brand/Supplier Grade Approx.Age Ste el/Fibergtass <br /> 6. TANK(S) INVOLVED > <br /> Location Cover <br /> Fells i Vents Siphons Pumps <br /> 7. INSTALLATION <br /> DATA <br /> North nitecie d­e.ay. conc,flt Black Too Sq. I I edit make.1 Suction.Remote. <br /> ti <br /> Aes,of staon,etc a,le, etc tunes.Remote FIII. Size.IiAreh.folcfao Which tanks I Make If known <br /> 8. UNDERGROUND Is the water over the tank? <br /> WATER Depth to the Water table F7 Yes 7 No <br /> Tanks to be filled— he Date Arranged by <br /> 9. FILL-UP Name Telephone <br /> ARRANGEMENTS Extra product to"top oft`and run TST7 How and who to provide 7 Cons,cle,NO Lead <br /> Terminal or other contact NOT APPLICABLE <br /> foe notice Of inquiry <br /> Cc,,pj,,V Name Telephone <br /> 10. CONTRACTOR, N01' AI�FLiUAbLt <br /> MECHANICS, <br /> any Other contractor <br /> Involved <br /> 11. OTHER <br /> INFORMATION NOT APPLICABLh, <br /> OR REMARKS <br /> Additional information on any ite,ns above Officials or others to be advised when testing is in progress or completed Visitors or observers present <br /> during test etc <br /> Tests were made on the above tank systems in accordance with test procedures prescribed for A_�_.i <br /> 12. TEST RESULTS as detailed on attached test charts with results as follows: <br /> Tank Identification Tight Leakage Indicated I Date Tested <br /> .-m 'A <br /> 1 A An <br /> 1AK 4 111al <br /> I h <br /> EA <br /> Thosof <br /> This is to ceirtity that these tank systems were tested on the date(s)shown. t\4'wHw%i IN-1 ti.".-i.Le <br /> 13. CERTIFICATION the National Fire Protection Asociabon Pamphlet 329. "a"i""ta"b"i"hed try <br /> PEWkill SFRV; L�� <br /> CHANPION'S PRECISION TANKTESTING <br /> Test,iNI tract.,Ar Cpm 1451 OAKHURK �f, S <br /> Ck'§7822 <br /> W of Thermal Tech-c—S Address <br /> I— <br />