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�risp Tank T <br />,Phone (209) 931-1828 <br />Post Office Box 30487 <br />Slocidon, California 9520 <br />�,­,L H1,41 TP <br />**rppo-lp ppt:)nl?lp** <br />i�Ll 248 <br />LEONARD E. CRISP <br />OWNER OF SITE: <br />--ADJJI- RAL <br />ADDRESS:P-91 A 0 C I TY: _'CA -Z I P <br />OWNER OF TANKS: <br />ADDRESS: CITY: ZIP: <br />OPERATOR AT LOCATION: Pra&heoj iaot <br />ADDRESS: CITY: 11J. d jj �p C L4 ZIP: <br />COUNTY: &Wll I V) TANK A G E GALLONS: <br />v <br />METAL FIBERGLASS'( ) SINGLE WALLED((-) DOU13LE WALLED( <br />DIESEL( UNLEADED( ) PREMIUM UNLEADED( <br />WASTE OIL( KEROSENE( AVIATION GAS( ) JET FUEL( WATEIIIJ <br />SUCTION( ) SUBMERSIBLES..) OVERSPILL CONTAINER--YFc3( NOS/,) <br />SHEARVVALVE--YES(4)- NO( ) IN-LINE LEAK DETEC'T'OR --YES( NO(V) <br />VAPOR RECOVERY SYSTEM --YES ('I) NO( *IF YES, PHASE 1('V) 1111ASF 2. (l:') <br />TANK FILL DATE: ,f�))WjC!4TIME: UQ(_) <br />TANK TEST DATE:11_(_iql_START: END:4,,l �m T <br />ILENG,OF EST: <br />14, <br />TANK BOTTOM TO GRADE....TEST LEVEL TO TANK Borrom_jLVD' <br />TANK TOP TO GRADE .......__ ;5 -1 " GROUND WATER ABOVE TANK.. <br />DIAMETER ................ PSI ....................... <br />TEST LEVEL ABOVE GROUND. NET TEST PRESSURE........ <br />WATER IN TANK...........____ API SPEC GRAY........... Z) <br />DEPTH FOR TAKING SAMPLE. tiY TEMP ......................... (f <br />TEMPERATURE PROBE DEPTH. CA API SPEC GRAV @ 66' <br />COEFICIENT OF EXP ........ oCJOL)tL�5q� <br />CERTIFIED TIGHT--YES(V) NO( LEAK RATE PER/HR:+ I -AL 410 <br />PRODUOTLINE TEST --PASS(//) FAIL( <br />CERTIFIED TIGHT --YES(/) NO( ) <br />COMMENTS: <br />SUCTION( ) PRESSURE(/,) <br />LEAK RATE PER/lIR: + _/- J� <br />DATE: (D SIGNATURE OF TESTER,- ' <br />REV 3/92 <br />1, <br />0 <br />