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Sacramento � Equipment' Mai nance Company;jnc.` -- ��--- <br />2533 Connie Drive , Calif. Contr. License #502377 <br />Sacramento, CA 95815` <br /># 62995 <br />(916) 925-2716 t wo <br />PLEASE PRINT Data ® nk Sy 7 tobf6gs Test Station # 213 3 <br />rr ., <br />3. REASON FOR <br />TEST <br />(Explain FuIW <br />4. WHO REQUESTED <br />TEST AND WHEN <br />Arco P -0 -Box 6411--:lA►rtesia Ca. Courtland Holman(415)571-2422 <br />Name T <br />Nana tabus Telephone <br />Arco 2908 Benjamin Holt Dr. Stockton Ca. (209)478-5552 <br />Name Address Telephone <br />Countv Permits <br />Address <br />�. <br />1 `1 '1/':f <br />WATER <br />s / > <br />8.FILL•UP <br />ARRANGEMENTS <br />9. CONTRACTOR. <br />MECHANICS, <br />any other contractor <br />Invoked <br />10. OTHER <br />INFORMATION <br />OR REMARKS <br />11. TEST RESULTS <br />12. SENSOR <br />CERTIFICATION <br />aantal No. of Therml <br />sensor <br />Tanks to be faked he. Date Affarged by <br />Name Telephone <br />Extra product to I" oN" and nun tank aster. lbw and art b provide? Consider No lad. <br />TerocreN or other contact lk <br />lor notice or kWulrY <br />Company NamT® <br />Additional Nttonnotloe on any item atwve. OfaclNs or others b be advDad when l st" Is M progress or complabod. Vlsaoe or observed present during teat, etc. <br />Tests were made on the above tank systems in accordance with test procedures prescribed for (' <br />as detailed on attached test charts with results as follows: <br />Tank tderntiation Tight /� Ode Tested <br />eGA /_.A/ !_.w®^�.. w .• , ick — wn�n /_ /Jit I I— /n BG . <br />13. This Is to certify that these tank systems were tested on the date(s) shown. Those Indicated as "Tight' meet the criteria established by <br />the National Fire Protection Association Pamphlet 329. <br />T no it is the responsibility of the owner and Ior operator of this system to immediately advise state and local authorities of any <br />implied hazard and the possibility of any reportable pollution to the environment as a result of the indicated failure of this <br />1. �=' system. Heath Consultants Incorporated and/or SACRAMENTO EQUIPMENT MAINTENANCE COMPANY, INC. does not <br />assume any responsibility or liability for any loss of product to the environment. <br />cefa a fi, 90 --11 ? ti <br />2Nl`1V11 l fa <br />Certiacadon 0 Tank Owner/Operator Data 40 -7 — <br />101 <br />Idecitify by Direction <br />Capacity <br />Brond/SuppltaGraft <br />Approx. Ape <br />Stsel/Rberglass <br />5. TANK INVOLVED <br />R �' <br />! <br />j <br />eke additional lines <br />for atantfotded tanks <br />Location <br />Cover <br />Fills <br />Vents <br />Pumps <br />6. INSTALLATION <br />DATA <br />5p�viH W613 <br />toRn�.t2 ®ice /�c/JG. <br />coficiet$r'it <br />9 <br />North Inside driveway. <br />Am W station. eta <br />Concrete. Black Top. <br />Earth• eta <br />Size, TWN auks. Drop <br />tuba. Remote FdIs <br />Size. Manitols <br />Which tanks? <br />suction. <br />Maks a known <br />1 `1 '1/':f <br />WATER <br />s / > <br />8.FILL•UP <br />ARRANGEMENTS <br />9. CONTRACTOR. <br />MECHANICS, <br />any other contractor <br />Invoked <br />10. OTHER <br />INFORMATION <br />OR REMARKS <br />11. TEST RESULTS <br />12. SENSOR <br />CERTIFICATION <br />aantal No. of Therml <br />sensor <br />Tanks to be faked he. Date Affarged by <br />Name Telephone <br />Extra product to I" oN" and nun tank aster. lbw and art b provide? Consider No lad. <br />TerocreN or other contact lk <br />lor notice or kWulrY <br />Company NamT® <br />Additional Nttonnotloe on any item atwve. OfaclNs or others b be advDad when l st" Is M progress or complabod. Vlsaoe or observed present during teat, etc. <br />Tests were made on the above tank systems in accordance with test procedures prescribed for (' <br />as detailed on attached test charts with results as follows: <br />Tank tderntiation Tight /� Ode Tested <br />eGA /_.A/ !_.w®^�.. w .• , ick — wn�n /_ /Jit I I— /n BG . <br />13. This Is to certify that these tank systems were tested on the date(s) shown. Those Indicated as "Tight' meet the criteria established by <br />the National Fire Protection Association Pamphlet 329. <br />T no it is the responsibility of the owner and Ior operator of this system to immediately advise state and local authorities of any <br />implied hazard and the possibility of any reportable pollution to the environment as a result of the indicated failure of this <br />1. �=' system. Heath Consultants Incorporated and/or SACRAMENTO EQUIPMENT MAINTENANCE COMPANY, INC. does not <br />assume any responsibility or liability for any loss of product to the environment. <br />cefa a fi, 90 --11 ? ti <br />2Nl`1V11 l fa <br />Certiacadon 0 Tank Owner/Operator Data 40 -7 — <br />101 <br />