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0'ata 16artfor Tank Sly <br />PLEASE PRINTPE HEC <br />1. OWNER Proportr iiam LiQuQr 130 Woe.Kettl <br />e tYa)tljtld)''� Name Address' <br />Name Address <br />2. OPERATOR <br />3. REASON FOR <br />TEST <br />(Explain Fully) <br />4. WHO REQUESTED <br />TEST AND WHEN <br />Address <br />Representative <br />Regulation governing unaergrouna storage oz nazaraous suostances. <br />Telephone <br />Sub -Chapter -16 of Chapter -3 -Title -23- of the California Administrative <br />Code. <br />Pete Graffi 3/7/88 <br />ITU <br />�+ mA Ile Compenv or Affiliationion1 West Kettleman Lane, Prodi, CA 95240 (209) 334-32163 <br />Address Telephone <br />5. WHO IS PAYING <br />FOR THIS TEST? Company. Agancy or I <br />Bitting Address <br />City <br />Other Instructions <br />State <br />Identify by Direction <br />Capacity <br />Brand/Supplier <br />Grade <br />Approx. Age <br />Steel/Fiberglass <br />6. TANK(S) INVOLVED East <br />10,000 <br />--- <br />Regular <br />--- <br />Steel <br />Center <br />10,000 <br />--- <br />Unleaded <br />--- <br />Steel <br />West <br />10,000 <br />--- <br />Prem. Unl. <br />--- <br />Steel <br />Location <br />Cover <br />Fills <br />Vents <br />Siphones <br />Pumps <br />7. INSTALLATION Front, So. <br />DATA of Store <br />Concrete <br />411 <br />211 <br />No <br />Remote <br />Northinside drivewev. <br />Real of station. etc. <br />Concrete. Black Too. <br />Earth. etc. <br />Size. Titefill make, Drop <br />tubes. Remote Fills <br />Size. Manifolded <br />Which tanks? <br />Suction, Remote. <br />Make if known <br />8. UNDERGROUND Is the water over the tank t <br />WATER Depth to the Water table Below Tanks yes No <br />Tanks to be filled hr. Date Arranged by _ <br />9. FILL -UP Name Telephone <br />ARRANGEMENTS Extra product to "top off' and run TSTT. How and who to provide? Consider NO Lead. <br />10. CONTRACTOR, <br />MECHANICS. <br />any other contractor <br />involved <br />OTHER11. <br />INFORMATION <br />OR REMARKS <br />12. TEST RESULTS <br />Terminal or other contact <br />for notice or inquiry <br />Company Name Telephone <br />Additional information on any items above. plhCials or others to be advised When testing is in progress or completed. Visitors or observers present <br />during test etc. <br />Tests were made on the above tank systems in accordance with test procedures prescribed forTt4aa <br />as detailed on attached test charts with results as follows: <br />Tank Identification Tight Leakage Indicated Date Tested <br />Regular Tight None_ 1 <br />Unlead Ti ht None 3/16/88 <br />Prem. Unlead Tiqht None 3/16/88 <br />This is to certify, that these tank systems were tested on the dates) shown. Those indicated as "Tight' m the criteria established by <br />13. CERTIFICATION the National Fire Protection Asociation Pamphlet 329. n �\ <br />3116/A8 Bill Campbell PETRO -CHECK, INC. <br />at� — Testing Contractot or Company. By Signaturo <br />1808L1972,1819 #414811816 271 OPPORTUNITY ST., SUITE C SACRAMENTO, CA <br />Satal No. of Thermal Technicians Address 95838 <br />Sensor <br />