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Champion P.O. Box 13059 <br /> Sacramento, CA 95813-3059 <br /> Precision Tank Testing CA 800-660-9443 <br /> License No. 73848 <br /> NEV 800-949-9443 <br /> PETRO-TITS II CERTIFICATION: (916) 927-1557 <br /> Fax: (916) 927-7345 <br /> ' OWNER: <br /> ' PROPERTY [ ] <br /> ITANK(S) [ ] <br /> NAME ADDRESS CITY STATE <br /> IOPERATOR n +T L Loll U.)/_% Tzw0 1Z ?D '1'Ut1 <br /> NAME ADDRESS CITY STATE <br /> REASON REGULATION GOVERNING UNDERGROUND STORAGE OF HAZARDOUS SUBSTANCES <br /> FOR TEST SUBCHAPTER 16 CHAPTER 3 TITLE 23 OF CALIFORNIA ADMINISTRATIVE CODE: <br /> TANK(S) DIRECTION CAPACITY GRADE SUPPLIER <br /> INVOLVED nl!D Q,Ogg UM.t)' <br /> f R V tip f LD <br /> ( TANK TYPE STEEL [XI FIBERGLASS [ ] DOUBLE WALL [ ] <br /> COVER EARTH [ ] CONCRETE N1 BLACK TOP [}C] <br /> INSTALLATION LOCATION FILL VENT OMMPUMPS <br /> 3 <br /> UNDERGROUND DEPTH TO WATER TABLE FROM GRADE 01IS THE WATER OVER THE TANK(: <br /> WATER YES [ ] NO [ ] WELL POINT IN TANK PIT YES [ ] NO [ ] <br /> FILL -UP TANK(S) TO BE FILLED: HR DATE <br /> ARRANGEMENTS EXTRA PRODUCT TO "TOP OFF" AND RUN TANK(S) TEST: HOW AND WHO TO <br /> PROVIDE? TESTING CO. TERMINAL OR OTHER CONTACT FOR NOTICE OF INQUIR:' <br /> CONTRACTOR <br /> ' MECHANICS <br /> OTHER <br /> INFORMATION <br /> OR REMARKS <br /> TEST METHOD PETRO-TITE II [X] SELF LEVELING STANDPIPE [X] DTS. 2,000 [X] <br /> TEST TANK(S) TIGHT NET VOLUME DATE <br /> RESULTS IDENTIFICATION CHANGE PER HR. TESTED <br /> r1Ltl " •D3 i I -! 4 <br /> yJP U YlG-r--) PA65 .6;5,w !1 ® ! to —C4 H <br /> SENSOR TECHNICIANS COMPANY <br /> CERTIFICATION WILLIAK R CAMPBELL CHAMPION PRECISION TANK TESTING <br /> 1 23 92 CALIF. 92-1324 1875 NO 12 DIESEL DRIVE <br /> SERIAL NO NEV. UTT-1010 CR O CALIF 95813-3059 <br /> 418 <br />