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I Data Art for Tank <br />PLEASE PRINT l jj <br />1. OWNER Property ❑Flam Liquor 1301 W. Kettlem <br />Tank(s) O Name Address <br />Name Address <br />2. OPERATOR <br />Name Address <br />3. REASON FOR Regulation governing undergrol. <br />TEST Sub -Cha ter -16 of Cha ter-3-Tj <br />(Explain Fully) Code. <br />4. WHO REQUESTED Pete Graffigna <br />TEST AND WHEN 1'361 West Kettleaun Lane, t�iffl <br />5. WHO IS PAYING <br />FOR THIS TEST? <br />Tight ss Test <br />W <br />�t..vtcayc vs iaac.a..uvu� our✓ouaai�.c�. <br />e-23- of the California Administrative <br />3/7/88 <br />CA 95240 Company of Affiliation ( 209) 334-32n <br />) Company, Agency or Individual Person Authorizing Title Telephone <br />Attention of: <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 />10,000 <br />--- <br />Unleaded <br />--- <br />Steel <br />Center <br />10,000 <br />--- <br />Prem. Unl. <br />--- <br />Steel <br />West <br />Location <br />Cover <br />Fills <br />Vents <br />Siphons <br />Pumps <br />7. INSTALLATION Front, So. <br />DATA of Store <br />Concrete <br />Ott <br />211 <br />No <br />Remote <br />North inside driveway. <br />Rear of station, etc. <br />Concrete, Black Top. <br />Earth, etc. <br />Size. Titefill make. Droo <br />tubes. Remote Fills <br />Size. Manifolded <br />Which tanks? <br />Suction, Remote. <br />Make if known <br />8. UNDERGROUND <br />WATER <br />9. FILL -UP <br />ARRANGEMENTS <br />10. CONTRACTOR, <br />MECHANICS, <br />any other contractor <br />involved <br />Depth to the Water table Below Tanks <br />Tanks to be filled hr. Date Arranged by _ <br />Name <br />Extra product to "top off' and run TSTT. How and who to provide? Consider NO Lead. <br />Is the water over the tank J <br />El Yes 0 No <br />Telephone <br />Terminal or other contact <br />for notice or inquiry <br />Company Name Telephone <br />11. OTHER <br />INFORMATION <br />OR REMARKS <br />Additional information on any items above. Officials 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 for P�fO j ds <br />12. TEST RESULTS as detailed on attached test charts with results as follows: P'°M R- <br />Tank Identification I Tight Leakage Indicated i Date Tested <br />Regular I Tiaht None13/16/88 <br />Z <br />This Is to certity that these tank systems were tested on the dates) shown. Those indicated as "Tight" Wrest the criteria setsibashaid by <br />13. CERTIFICATION this National Fire Protection Asociation Pamphlet 329. <br />al/i ti SS Bill Campbell PEIRO-a=, INC. <br />Oats Testing Contractor or Company. BySignature <br />#1808,1972,1819 #414811816 271 OPPORTUNITY ST., SUITE C SACRAMENTO, CA <br />SO" No. of Thermal Technicians Address 95838 <br />Senor <br />