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dfis Tank TA%nv a %oonstrucOn company <br />Phone (209) 931-1824 Licensed <br />Pod Office Box 30487 Insure <br />Slocidon, California 95213 <br />**TEST REPORT** <br />OWNER OF SITE: al}n v x <br />ADDRESS: - 3 j2,9 CITY:AA J ZIP <br />OWNER OF TANKS:®� s <br />ADDRESS: CITY: 7IP: <br />OPERATOR AT LOCATION: P r a q k <br />ADDRESS: fgCITY : C rG, zip: <br />COUNTY: TANK #: AGE: f 'S GALLONS : JL'r <br />METALO FIBERGLASS( ) SINGLE WALLED(".) DOUBLE WALLED( ) <br />DIESEL( ) UNLEADED( ) PREMIUM UNLEADED( ) 1'(f' (' <br />WASTE OIL( ) KEROSENE( ) AVIATION GAS( ) JET FUEL( ) WATER( } <br />SUCTION( ) SUBMERSI`BLE�4,) OVERSPILL CONTAINER--YES( ) NO <br />SHEARVVALVE--YES(t4 NO( ) IN-LINE LEAK DETECTOR--YES( ) NO(} <br />VAPOR RECOVERY SYSTEM --YES( NO( ) *IF YES, PHASE 1(V) PHASE <br />TANK FILL DATE: IME : UOb <br />TANK TEST DATE: START: END: a:� LENGTH OF TEST:_- h ;:_ <br />TANK BOTTOM TOGRADE.... TEST LEVEL TO TANK BOT`T'OM__ `';s'..?___ - <br />TANK TOP TO GRADE....... �� GROUND WATER ABOVE TANK.-___`b— <br />DIAMETER ... <br />ANK.. b— <br />DIAMETER... �°�? PSI ....................... <br />TEST LEVEL ABOVE GROUND._ NET TEST PRESSURE........ <br />WATERIN TANK........... API SPEC GRAV............ <br />' DEPTH FOR TAKING SAMPLE. TEMP..................... _ <br />TEMPERATURE PROBE DEPTH. APF SPEC GRAY @ 60' F.... J <br />e <br />COEFICIENT OF EXP........fi ) <br />CERTIFIED TIGHT--YES NO( ) LEAK RATE PER/ITR : + ®- ' <br />PRODUCT LINE TEST--PASS(;) FAIL( ) SUCTION( ) PRF.SSURE(�',,) <br />CERTIFIED TIGHT--YES') NO( ) LEAK RATE PER/HR:+ <br />COMMENTS: <br />DATE: SIGNATURE OF TESTER 0"' " t .�. <br />REV 3/924 <br />