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• Data Cha or Tank SystemTightne Test <br />• In., aq 0 0 <br />PRINT <br />3WNER Property ❑ <br />k CHAM1­`IUN-!.5=-VRE,GkZUUE4 TAN& J <br />Flame Liquor 1301 Kettleman Lane, Lodi, <br />California <br />Tank(a) ❑ <br />Brand/Supplier Grade <br />Attn: PIETL' Graf f igna <br />"'O••••...l"' <br />N.m. AOO..a• <br />R.o.... nt.l... T«.pndn. <br />OPERATOR <br />WI <br />N. m. <br />I--3CM 'WE -5T fSt <br />Add...• <br />r=- =1 I1 <br />t.l.Ohdn. <br />REASON FOR <br />REGULATION <br />GOVERNING UNDERGROUND STORAGE OF HAZARDOUS SUBSTANCES <br />TEST <br />SUBCHAPTER <br />16 OF CHATTER 3 OF TITLE 23 OF <br />THE CALIFORNIA ADMINISTRATIVE CODE <br />(Explain Fully) <br />nis <br />WHO REOUESTEO <br />OWNER <br />TEST AND WHEN <br />Name <br />Im, <br />Cd-o.ne or Atta"ilon Dole <br />WHO IS PAYING OWNER <br />FORTHIS TEST? Comp.ny. Ad.nc. or Individual f..... Aulho,ump T.o. T.l.onone, <br />Bia,r,e Address Cite Sul. 2.0 <br />Atu.tron Of. Order No Otn.r In.Iruc tions <br />1. CERTIFICATION <br />1-30-91 <br />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 Asociatlon Pamphlet 329. <br />We 0�A, CiHAMPION' S PRECISION TANK TESTING <br />Box 13059 n,.a c°m B. s . <br />P0- • CRAI�EI�TO , CA.od � � 18 '13-3059 <br />Identify, by Direction <br />Capacity <br />Brand/Supplier Grade <br />Appro.. Ape <br />Steel/Fiberglass <br />TANK(S) INVOLVED <br />M6 <br />10 ') <br />rz , <br />nis <br />l <br />ET2 <br />r) IsiJ <br />;` <br />zw, t t <br />Location <br />Cover <br />Fills Vents <br />I Srphones <br />Pumps <br />INSTALLATION <br />i <br />DATA <br />401 oe OF <br />61CR� <br />, / <br />tw i TM <br />North ino,d. a..v.w.y. <br />RNr of f1.1,on- .1C <br />Conclele. Black Too. <br />E.,I-. etc. <br />Sir., T.I.f.11 mole, D,.o I t <br />tubes. Remole F.IIt S.A. M.n.lolO.d <br />Which W.I. � <br />Suction. <br />Ma►. rl ►mown <br />�. <br />UNDERGROUND <br />Is it** waist over the tank T <br />WATER <br />Depth to 1M Water table <br />❑ yes ❑ No <br />9. <br />FILL -UP <br />Tanks to be hlledO Uhr. I ya~' I Date Arranged ov <br />Tel•ohon. <br />ARRANGEMENTS <br />Extra product to top off- and run TSTT How and who to provide Consider NO Lead <br />STIn <br />Terminal or other contact ��. ``I \ ,� �✓tu �y j � a 4�."�C �i <br />for notice or inQu,ry V <br />-`„�1�,.,� �'' I`, r' 'V �,..r'M <br />COmo.ne <br />N. me ie..OhOne <br />t0. <br />CONTRACTOR. <br />MECHANICS. <br />any other contractor <br />�1. <br />OTHER <br />---- -- - ---- -- ----- <br />- — <br />INFORMATION <br />OR REMARKS <br />Add.t,ona! information on any .tens above 011 -coals or otners to be advised when testing .s .n progress or completed Visitors or observers present <br />during Ies, etc <br />Tests were made on the above tank systems to accordance with test procedures prescribed <br />for PETRO-TITE <br />2. <br />TEST RESULTS <br />as detailed on attached test charts with results as follows: <br />Tans Iden!A.cat.on Leakage tnd,c aced <br />Date Tested <br />►- <br />1. CERTIFICATION <br />1-30-91 <br />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 Asociatlon Pamphlet 329. <br />We 0�A, CiHAMPION' S PRECISION TANK TESTING <br />Box 13059 n,.a c°m B. s . <br />P0- • CRAI�EI�TO , CA.od � � 18 '13-3059 <br />