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rnat CHAMPION <br /> • — � TANK CERTIFICATION P»elsion Tank Testing <br /> 'CHEK� 3059 <br /> leak d � ��cha <br /> REPORT Box i <br /> r Saaamto.CA <br /> 95813-3059 <br /> Property Q' Z—Q Pe i t. S 7-,Jt— <br /> OWNERS .• ee101e <br /> NAME Tank(S) �' _ tat°X -71 G o t7 i 4 S• / <br /> eaaesn G+v Zo <br /> NAME OF 2 1.4L 5 7-4t- <br /> NAME <br /> -.4G o209 3:i y 3g i <br /> LOCATION 9'75 7 -� _ rJi <br /> Aar® Car o <br /> NOTICE TO OWNER A copy of all teat results have been tiled with tto proper regulatory agency gwerning underground <br /> a <br /> storage systems. Yeo O No O If not filed. we explanation below. <br /> RECORD OF <br /> FILING <br /> !_ocabon of agency where filed: <br /> REASON FOR <br /> TEST <br /> (Explain FLAY) NCTIC£It is the owner** respormbft to contact the em ronmentai health departrnent of any fair•,wain 24 Its.of the resuR3 <br /> given to the owner. <br /> WHO REOUESTED RAM <br /> TEST AND WHEN? <br /> aaay. <br /> •.nmr CAW." Ckaas Approa.AT flay r Fear¢.ss <br /> 1 �r <br /> MOR TESTED <br /> O <br /> TANK ONLY <E O fa U• A.G c a= s S tY <br /> '. <br /> O 0 <br /> P40L7-.)CT UNE 8'' <br /> VWj1 ,,1E O o <br /> VAPOR UNE ® O O <br /> ALL OF THE ABOVE 0 O 0 <br /> True•to Us0 a, <br /> FALL- l�C'olgdi7T l�'�T/2oLELt(K <br /> ARRANGEMENTS Nave. <br /> Eaa paua b,op oir YES <br /> OTHER <br /> INFORMATION <br /> OR RELAARKS ' <br /> Ada"nao onwrnauon on"leans stove Ods at ours to be adosoO when NOW9 n in progress or Coffokpied VMWS of ODw*vws•reesM awwq <br /> e•ne etc <br /> Taw were me"on neo above tak siob$m*0 wdh etener UY CMma Lsak and <br /> TEST RESULTS ver se•oom"ss a led Choll Naw.r as lung..: <br /> ^�- Tara I TWO Tbea T tss `,eeveevowmes Tana I.eevesee+eoarste+wN Cwt Tei-- <br /> 2 <br /> TANKS .t n// A C rea w O r« !i,w 0 `' �t —$_ Z <br /> LINES O'er <br /> ales O we 0 Vas O ee. ® ....._. <br /> 6 vent Yes 0� T.$ O No 0 s.s O u• O <br /> Lines k4luded No 0 ales O Wa o eve G we O <br /> Tes 0 go O Yes C les 0 <br /> CERTIFICATION Thi$ Ism cartity that thew tank$yam'"'$wwo tnW an the dist•($) shown. Those m-Ttpft'wad 00 utk•tle by . <br /> ave National Fire ion Association(P 320). <br /> ZE oY /Lf tC�'� <br /> Oat$ <br /> _. Technicians: --- ----- <br />