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4 <br /> 8 { <br /> Data r Tak Systemi <br /> CS&VITON's <br /> PLEASE PRINT <br /> 1. OWNER Property ❑ 1RMC LONESTAR P.O. Box 5252 Pleasanton,I,California '. <br /> Name �- Address R nishve Totephone <br /> Tank(s) ❑ tate! 415-426-2279 <br /> Noma - - Address Reo.esentatrvs TalrDphone <br /> 2. OPERATOR ' 50 S Tracy Blvd. , Trac <br /> Pismo Address Toleprione <br /> 3. REASON FOR _RSGUIATIQN GOjjME_RGR0UND STORAGE AMM; <br /> TEST SUBCRkPTER 16 OF CFAPTER 3 OF TITLE 23 OF THE CALIFORNIA ADMINISTRATIVE CODE <br /> (Explain Fully) <br /> i. WHO REQUESTED OWNER <br /> TEST AND WHEN Name Tme Compenv of Amhaom pate <br /> Addroat Telephone <br /> 5. WHO IS PAYING OWNER <br /> FOR THIS TEST? Company.^sono at Inalwouai Person Awmonzing Trp, Telephone <br /> flithne Addnm city Stats Zoo <br /> Attention of: order No. omen Instructions <br /> Identity by Direction Capacity Brand/Suppler Grade Approx.Age Steel/Fiborglass <br /> 6. TANK(S) INVOLVED P P6- <br /> s <br /> tt�5 1 D,000 <br /> T. INSTALLATION Vr cover ` tverw/ -n �* STS r; <br /> DATA �� is � let <br /> Plicift inside driveway. Concrete,stack Top. Size,Tia"make.prop Suction.Remelts. <br /> Rest of session.otc. Earth.oft. tweak.Remote Fras SAM M which tanks? Make of known <br /> 8. UNDERGROUND is the water over ere tank? <br /> WATER Depth to to wast table ❑ res (� No <br /> Taf�s to to fwd hr. oats by- <br /> 8. FILL-UP a T <br /> ARRANGEMENTS Extre product to-top off`arta run TSTT. Now and who to i Conseder No Load. <br /> Termtnal or other contact N O T APPLICABLE <br /> for notice or inquiry <br /> Company Name Toeonom <br /> 10. CONTRACTOR. NUT AFFLICABLE <br /> MECHANICS, <br /> any other contractor <br /> involved <br /> 11. OTHER <br /> INFORMATION N01 ftPPtfe11J31tt <br /> OR REMARKS <br /> Additional information on any items above,Officials or others to be advised when testing,s in progress or completed.Visitors or observers present <br /> during test etc. <br /> Tests wers mads on the above tank systems in accordance with test procedures prownted for t0 <br /> 12. TEST RESULTS as detailed on attached test ChNU with results as follows: <br /> Tank Identification Tight Leakage indicated Date Tested <br /> ID 0 `' r• > t C�64 47 <br /> i 1►a 4'wrL.. �' �`' i �t � � �r r`,Aa <br /> This is to c that chess tank systems were tested on to date(:)shown.Those indicated as mot the criteria established by <br /> 13. CERTIFICATION to National Fire Protection Asociation PamphNt 329. <br /> t is ION'S PRECISION TANK TESTING <br /> Tetnn Contractor or Com an r rr Cr„r TO^ s822 <br /> z 1451 OAST Y, SACR <br /> Sonat No of Therm,! Technrc.a" Address <br />