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Crisp Tank Telling & ConstruclMn Company <br />Phone (209) 931-1828 Licensed <br />Post OffIce, Box 30487 Insured <br />Stockton, Callfornla 95213 1,1117"7 iSE #92-1248 <br />*'TEST' p r <br />1-,"IDNARD E. CRISP <br />OWNER OF SITE: _§T_on <br />ADDRESS :�-a.-Aa- zi P <br />OWNER OF TANKS: (9 <br />ADDRESS: CITY: <br />OPERATOR AT LOCATION: zl�2_0114d <br />yo C! <br />ADDRESS: ;�?o Z'7 (--t/' 'VG e CI'T'Y:Aecd ZIP: <br />A )R!) <br />COUNTY:(TANK AGE V,,P,5 .(3AT,LOHS- o I -L <br />v F <br />METAL (V-) FIBERGLASS( ) SINGLE WALLED( ) DOUBLE WALLED( <br />DIESEL('V� UNLEADED( PREMIUti <br />UNLEADED( ) <br />WASTE OIL( KEROSENE( AVIATION <br />GAS( ) JET FUEL( <br />WATER( <br />SUCTION( ) SUBMERSIBLE( OVERSPILL CONTAINER --YES( <br />NO (V-) <br />SIiEAR','VALVE--YES(V) NO( ) IN-LINE LEAK DETECTOR--YJ`,S( <br />NO(K) <br />VAPOR RECOVERY SYSTEM --YES( NO( ) <br />*IF YES, PHASE 1( <br />PHASE 2( <br />000 <br />TANK FILL DATE:1 M E <br />TANK TEST DATE: 5ic)_�lqj-START:_Lj0 Q 3b LENGTH OF <br />TFST-_��:)LM <br />TANK BOTTOM TO GRADE... <br />`.T'ES'T' LEVEL T 0 TANK B wrr <br />o m <br />TANK TOP TO ) GRADE ( _ 0" <br />GROUND WATER ABOVE TANK.. <br />DIAMETER . -i ............. <br />111SI ...................... <br />TEST LEVEL ABOVE GROUND.— <br />NET TEST PRESSURE ......... <br />WATER IN TANK ........... <br />APT SPEC GRAV ........... <br />DEPTH FOR TAKING SAMPLE, <br />TEMP ..................... <br />2 <br />TEMPERATURE PROBE DEPTII.JV'14117,_" <br />APT SPEC GRAV 0, 60' F.... <br />a5' 1+33' <br />COEFICIENT OF EXP........ <br />.)b <br />CERTIFIED TIGHT--YES(V) NO( <br />LEAK RATE PER/11R:+ <br />PRODUOT LINE TEST --PASS'('.) FAIL(-) <br />CERTIFIED TIGIIT--YES( ) NO( ) <br />COMMENTS: <br />SUCTION( ) PRESSUREI) <br />LEAl"k RATE PER/lIR-+ <br />DATE:1/)14 1 c SIGNATURE OF TESTER: <br />t <br />REV 3/92 (_'z <br />N <br />E <br />11 <br />