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Tank cad Moaitor Suaawary <br />Location Pacific Bell Geo/Par-,elUE-020 <br />Address m S t r e e t CLLC: <br />City Lodi Tank 7 -95 - <br />County Tank Pon -nit # not noted by te <br />Zip Expiaation Date <br />Iosp"doa Record <br />Uaderrgrouod Storage Ta►ok <br />Tank5izc:w FroductjFucllevelCtcst.2(�,,gal.�34 Monitor__55.5 Stick <br />Agency requiring Cortific4tioa: San anaclu i n Hea t tb <br />Agency signature; N / n requirod to be ou site? no <br />Required Testing: Teaks no A%nl.a! &rv)"Iy Iw uW; no Aru,ual Arwually <br />Testing Permit Required Yes No <br />Test Type: <br />Test Date. 8-22.26 <br />Test Performed By. Company See below <br />Contact: <br />Phon1'0<r <br />Test Results: Pass/ Fa:! <br />Remarks: d <br />at this time, <br />`tooitorWg System <br />uf"r=r. Veed oot Model: 22065 <br />Agency Requiring Certification Same As, above <br />Agency Sigrtatwe: NSA Required to be: oo site? no <br />Required Testing: XX AP.-. 4.4 Sems•Annual Annually <br />Testing Permit Required: Yes -----X—No <br />Test Type: <br />Test Date: <br />Test PcrformedBy; ComP,:.ny DTALYSTS COMPANY <br />Cor --'V, James or Tamara Zimmerma <br />Pho.-'t 800 227-7879 <br />Tested oy. James Zimmerman <br />Test Results: pass Pass / Fail <br />Remarks: <br />functioning as er manuf d <br />th overspill well -and sumo <br />Date of Next Tests. <br />Serial: <br />