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CHAMPION PRECISION T` <br /> DATA CHART FOR PETRO—TITE TANK SYSTEM TIGHTNESS TEST: <br /> P.O. BOX 13059 SACRAMENTO, CALIF. 95813-3059 <br /> ASE PRINT CALIF: 1-8DG-660-9443 NEV. 1-800-949-9443 (916) 927-1557 l <br /> OWNER Property❑ <br /> Name Address Zip Representative Telephone <br /> Tank(s)❑ <br /> Address Zip Representative Telephone <br /> Name <br /> ORLANDO' S BAIT AND TACKLE 5611 <br /> WATERLOO ROAD STOCKTON CALIF <br /> OPERATOR <br /> Name Zip Telephone <br /> REASON FOR REGULATION GOVERNING UNDERGROUND STORAGE OF HAZARDOUS SUBSTANCES <br /> TEST SUBCHAPTER 16 '£HAPTER 3 TITLE 23 OF CALIFORNIA ADMIXISTRATI CODE: <br /> (Explain Fully) <br /> WHO REQUESTED Title Company or Affiliation Date <br /> TEST AND WHEN "8eE <br /> Address Zip Telephone <br /> Nientiy by Direction Capacity Brand/Supplier Grade Approx.Age Steel/Fiberglass <br /> TANK INVOLVED NORTH SOUTH 12 000 UNLEADED STEEL <br /> NORTHtZOUTH 10,000 DIESEL STEEL _ <br /> Use additional lines NORTH SOUTH 8 r 000 PREMIUM STEEL <br /> for manifolded tanks <br /> Location Cover <br /> Fills Vents Siphones Pumps <br /> INSTALLATION EAST BLACKTOP 4" WITH 2" WITH RED <br /> DATA SIDE AND OVERFILL VENT JACKET <br /> OF CONCRETE PROTECTION CAP TURBINE <br /> Is the water over the tank? <br /> UNDERGROUND <br /> WATER Depth to the water table from grade res "° WELL POINT <br /> [ ] <br /> S. FILL-UP TANK(S) TO BE FILLED: 0700 HR. 12/01/93 DATE <br /> ARRANGEMENTS Extra product to"top off-and run tank tester. How and who to provide? Consider NO Lead. <br /> TESTING CO. <br /> Terminal or other contact <br /> for notice or inquiry Company Name Telephone <br /> I CONTRACTOR, <br /> MECHANICS, <br /> any other contractor <br /> involved <br /> 10. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> Additional information on any items above.Officials or others to be advised when testing is in progress or completed.Visitors or observers present during test,etc. <br /> 11. TEST METHOD PETRO TITE # 2 SELF LEVELING STANDPIPE ANT) DTS. 2 , 000 <br /> Tests were made on the above tank systems In accordance with test procedures prescribed for <br /> Ila. TEST RESULTS as detailed on attached test charts with results as follows: <br /> Tank Identification Tight Net Volume Charge Per Hae Date Tested <br /> UNLEADED 2/01/93 <br /> DIESELPASS <br /> —.022 <br /> 2/01/93 <br /> PREMIUM PASS —.020 2/01/93 <br /> 12. SENSOR <br /> CERTIFICATION <br /> 1/23/92 Technicians <br /> Date WILLIAM Re CAMPBELL CHAMPION PRECISION TANK TESTING <br /> 418 CA. 92-1324 1554 JULIESSt ST. <br /> Serial No.of Thermal Codification a <br /> Sensor <br /> WILLIAM R. CAMPBELL SACRAMEN CALIF. 95813-3059 <br /> 2 <br /> Certification a NEV- U T T—1010 <br />