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or eaoe -- <br />Data Chart for Tank System Tightness Test <br />1. OWNER Property [T Unocal 76 2175 N California Blvd Tony Yap (415) 945-7676 <br />Tank(s) <br />Name Address Representative Telephone <br />Name Address Representallve Tetepbona <br />2. OPERATOR <br />InSin h -- 601 E._Kettleman Ln., Lodi, <br />---Name —Address <br />CA. 95240 <br />(201) 368-0715 <br />TNaphone <br />3. REASON FOR <br />TEST <br />(Explain Fully) <br />Ordiance Testing <br />4. WHO REQUESTED <br />TEST AND WHEN <br />Tony Yap Maintenance Representative Unnr^al 76 <br />January 1990 <br />Nart1e Tills Company or Affiliation <br />Oats <br />Address <br />Telephone <br />5. TANK INVOLVED <br />Use additional lines <br />for manlfolded tanks <br />Identify by Direction <br />South <br />Capacity <br />550 <br />Brand/Supplier <br />Waste Oil <br />Grade <br />N/A <br />Approx. Age <br />N/A <br />Stsel/Fiberglas° <br />Steel <br />— <br />6. INSTALLATION <br />DATA <br />Location <br />In back of <br />station <br />North inside driveway. <br />Rear of station, etc. <br />Cover <br />Concrete <br />Concrete. Black Top. <br />Earth, etc. <br />Fills <br />311 <br />Size. Titefill make, Drop <br />tubes, Remote Fills <br />Vents <br />11411 <br />Size. Manifolded <br />Siphones <br />N/A <br />Which tanks? <br />Pumps <br />No Pump <br />Suction, Remota, <br />Make It known <br />7. UNDERGROUND <br />WATER <br />Depth to the Water table <br />Is fhe water over the tank? <br />❑ res No <br />S. FILL -UP <br />ARRANGEMENTS <br />Tanks to be filled hr. Date Arranged M <br />Extra product to 'lop otr and run tank tooter. Now and who to provide? Consider NO Lead. <br />Name <br />Telephone <br />Terminal or other contact <br />for notice or inquiry <br />Company Name <br />Telephone <br />9. CONTRACTOR,— <br />MECHANICS, <br />any other contractor <br />Involved <br />10. OTHER <br />INFORMATION <br />OR REMARKS <br />Waste Oil Tank Tested With Diesel. <br />r � . • � ,. , <br />Additional information on any items above. Officials or others to be advised when testing is In progr, r m o rs FWt during test, etc. <br />Tests were meds on the above tank systems In accordance with test procedures for F in <br />as detalled on attached test charts with results as fo1)ows:��))2 O !Pin <br />Tank Identification Tight Leakage Indicated-. PY +�• felts Tested <br />11. TEST RESULTS <br />Waste Oil Tank <br />Yes -.04 <br />) <br />r�ary 2, 1990 <br />int <br />_o , <br />12. SENSOR <br />CERTIFICATION <br />February 2. 1990 <br />13. This is to certtfy that these tank systems were tented on the date(*) shown. Those Indicated <br />National Fla Protection Association Pamphlet 329` <br />Technicians <br />t.t,.-t i --- FNVIRONMFNTAL TANK T F S <br />as -Nhr meet the <br />1 l <br />F�'+L�l kt <br />a8eds established by Use <br />Q <br />DomP11­11 <br />� <br />1886 I �J----�- <br />Serial No <br />of Thermal Certification e 4 14 812 4 5 4 <br />Sensor <br />2 _ — <br />Certification e <br />I'_. R <br />P.O. BOX 1405 Testing Contractor or Company. By: Signature <br />Davis, CA. 95617' <br />Address <br />State License #1215 <br />PNOU <br />