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N <br />L <br />For Use With 13ASSETT CONSTRICTIONINC. <br />CA LIC. #3 <br />94-06 <br /><fAI R OAKS, CA 9 <br />1 LOCATION: e <br />Street No. and/or Corner s City Stele Telephone No. <br />2 OWNER: to /W° (1 SIf'l L " f IV <br />Name Address // Representative Position Telephone No. <br />3 OPERATOR: v k- <br />/Name Dealer, Mg®r. or Other Address (if dWerent than Location) Teienhone No. <br />11 <br />4 REASON FOR TEST—_ �1(6 &OPI P CA <br />6 TEST REQUESTED BY: __ fr^^ A) V Vy <br />Position <br />6 SPECIAL INSTRUCTIONS: <br />mainp Acores$ <br />7 CONTRACTOR OR COMPANY MAKING TE ii /�A jG 1 /`��L� ♦ I /� <br />MECHANIC(S) NAME f� (� (�jj (/ f �//\/ �✓' <br />8 IS A TANK TEST TO BE ❑ YES 9 MAKE AND TYPE OF t /tt jj �/ <br />MADE WITH THIS LINE TEST? �( PUMP OR DISPENSERSMAT) JA (/ � <br />NO COVER A APPROXIMATE <br />Who10 WEATHER r TEMPERATURE IN TANKS 'F 'C OVER LINES "` BURIAL DEPTH <br />' <br />Concrete, Black Top, etc. <br />11 IDENTIFY <br />EACH LINE <br />AS TESTED <br />12 TIME <br />(MILITARY) <br />13 LOG OF TEST PROCEDURES, <br />AMBIENT TEMPERATURE, <br />WEATHER, ETC. <br />14 PRESSURE <br />1b VOLUME <br />16 TEST RESULTS <br />psi OR kPa <br />READING <br />BEFORE AFTER <br />NET <br />CHANGE <br />CONCLUSIONS, REPAIRS AND COMMENTS <br />BEFORE <br />AFTER <br />z 0F <br />/(Q ® � <br />/AIC X,0 / <br />(gew I&. <br />JUN 1988 <br />NViROME TAL HEALTH <br />PERMIT/SERVICES <br />VPs VALVF, <br />u1_rag&Alf, <br />i <br />27� <br />3,96 <br />92, Z <br />V, <br />-- oho <br />lZu1.500 <br />lsd.3 <br />17f., <br />; l000f <br />