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►LEASE PRINT <br />Data fr rt for Tank System Tig ess Test <br />PetrO TttP <br />TAW TESTER ..r.. <br />1. <br />OWNER ►,opony ❑ <br />T.nkts) ❑ <br />Flame <br />NortH ArdnwN4re N 00 w <br />Flame Liquors, 1301 W. Kettleman Lane Lo i Ca (209)334-3233 <br />Ne" Aaarw wefrrMOrrMvrr .ieerhone V <br />2. <br />OPERATOR <br />Flame Liquors, 1301 W. Kettleman <br />Lane, Lodi <br />CA 95240 <br />Name Aadrett <br />Telephone <br />3. <br />REASON FOR <br />TEST <br />(Eap►.inFully) <br />Regulations governing underground storage of hazardous <br />substances, subchapter 16 of chapter 3 of title 23 of the <br />caliTornia Administration Co0e. <br />1 <br />4. <br />WHO REQUESTED <br />AND WHEN <br />Pete Graffigna <br />Flame <br />Liquors 8/15/86 <br />Data j <br />in* IrmoTEST <br />1301 W. Kettleman Lane, Lodi CA 95240 "'orAffiwaon -3233 <br />*Adieu <br />Tebphone 3 <br />5. <br />WHO IS PAYING <br />FOR THIS TEST? <br />Flame Liquors <br />Pete Graffigna <br />(209)334-3233 <br />"I�I-Alnc.'°12'"fleman Lane p— r& fT","'eCA 95240 "*' TMepnowe <br />04Nne A"mu coy state Zip . <br />Aflention of: order No. *dist tne"pMont <br />S. <br />TANK(S) INVOLVED <br />Identity, by Dvection <br />t.ap.oity <br />i nrid/Supplier <br />Gads <br />Approx. Ape <br />knelt/Fiberelm <br />1 <br />1u.cco <br />9E6-LA,Q <br />10 (S <br />2 ti1►ODL� <br />vh <br />C> C�' <br />1. <br />INSTALLATION <br />DATA <br />Location <br />U 'LA ) D {-��}- <br />p Q <br />North (nakN driveway. <br />Rot of station. sic. <br />C*var <br />Concrete. Wet Top, <br />E.nh. ek. <br />FiNs <br />a, C}f W <br />But, Tbd41 woke. Drop <br />a". Remote Fah <br />Vanu <br />fool), t <br />iW. WwMoWed <br />siphons <br />which MMs T <br />Pumps <br />neat= f <br />futlion. Remote. <br />ateke N known <br />8. <br />UNDERGROUND <br />WATER <br />Depth to one w... tabley I OL) <br />to ftl <br />Is ON wow o"" the tank? <br />❑fres V No <br />Tonka to he fww M. Dots A,,Wd by F 4 �* r .M TeiephorN <br />9. FILL -UP <br />ARRANGEMENTS E "a poduo to "sop *11" and run TETT. Mow end who la provide 7 Consider NO LoW <br />10. CONTRACTOR, <br />MECHANICS, <br />any Otirar oontraota <br />kwrAved <br />11. OTHER <br />INFORMATION <br />OR REMARKS <br />Termines w ORher condom <br />to motile a inquiry wevnorw <br />company Mears <br />•urine telt etc. <br />on any <br />or *then w be advised when 00me is M preen" W <br />Tad. farm MN% on NOW show WA eyMsml in soo"dowe wtM sea poo"Um pRMoflbitd iswtmmtr <br />12. TEST RESULTS M dean i on sowhw bw etwu Trkft ftt w u oa ka ws; <br />Tank WnMeatien I Tush, I L.ak,*. Indre.W I on+ <br />13. CERTIFICATION <br />I - V7( <br />00* <br />J6C111. LI <br />Or *beervore peeent <br />rd <br />Z- r t°4. c <br />Thea b to srwy ow M»w bnk ey.bnw wars bsbd on hep rsb($) dto , Tbw vtNoMod as "llo , IMM b sowis ssbhri hw ►y <br />rn NW, M ►►'barnArosiabon ►sn phW'ENYIROMAENTAL PEMOLEUM ENGN. • /not:L <br />(209) 943-1022 <br />