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HORHER EIY-CHEK TANK CERTIFICATION <br /> CHAMPION PRECISION TANK TESTING (916) 927-1557 (800) 660-4443 <br /> Lic # 73848 (800) 949-9443 Nv. <br /> Owners Property Tanks(s) <br /> Phone-(___-) <br /> Company a — -_�- - <br /> Address:- _ '""-�"""`�'� zip :— <br /> City -_.� State:__ M <br /> Name & Lo tion of CompanyPhone: n�.x - ZZ <br /> Company jL - -_ <br /> Address <br /> City; n� �- _„__M�.--------State i zip: <br /> ------ - TnAT «�•. TCtE <br /> fteagew ► Tt <br /> "UTICS TS o w ex Est t A CM°a OI TMai TEST "COULT BNS CR � MST" T6K <br /> antES3 To CEotT&CT T"t LOC"- t'.wr. STM me".. to <br /> ."WICZ® aT ES TM AEnr'noSESELETT A Tot <br /> ttEn/MLR AAE& E9I AMT Tame IAELEAK'S wETEt 621E MUM' <br /> Who Requested & When?_ ----__ <br /> Tank results Inc. Tanks—product Line,OVent Line,. Vapor Line❑ <br /> Identify Capacity Brand Grade Age Steel Fiberglass <br /> by ID# I 1 IV11 I <br /> 6N"Time <br /> Tanks to be filled; Date: i21 --- <br /> Distributor; ______Extra product to top <br /> Comments: <br /> ------ -- ---------- -- ---------------------------- <br /> _ _____________ <br /> _ n Am* Owe M®tEt AL Puny <br /> Rt/ARfCJtTEHels, so Aw.=4*1 wELL SE maTirttn t&KM TwE TEST "As <br /> P7t6SCAT AYAEw® TK TESTEwAALL TESTS name mo Tea! TANK451 STETEAt A&E v&Lt& Twt; &-Ea♦ x <br /> aK <br /> LBM KTECTEtwt 'ACES. 7";m CEATtrICATttlo nwCM T"C CRE4TAA LSTA�.t6MaCS 1T TM wATESwAl •ERC . <br /> ASfAC. E/Rwas't.ET 32'TE. ______ <br /> Test •Results Inc. Product Lines, Vent, and Vapor Lines <br /> Tank i Tight I Tight 1 Leak/Per Hrl Leak/Per Hr. t Date <br /> ID# I Tank I Lines I Ind.Tank I Detected LinelTesting <br /> I Y N D I Y <br /> O N <br /> 1 Y N O 1 M O N O <br /> t Y ® NO 1 Y O N '� <br /> I Y ® N (D I Y, O NO <br /> --t <br /> Y 0 N 0 1 Y 0 NO <br />