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0 Tank and Monitor Summary 0 <br />Location -Pacific Bell Geo/Parcel UE -020 <br />Address 124 W. Elm St CLLC: LO1 01 <br />City Lodi Tank i— 795 <br />County San Joaquin Tank Permit # 5203 <br />Zip a240 Expiration Date <br />Inspection Record <br />Underground Storage Tank <br />Tank Size:.4000 Db —prod.Dsl 1 level@ test-2Z.0R _gal&�.Q "Monitor 6 4. "Stick, <br />Agency requiring Certification:- q;; n j r) Ar-, n i n Ka a I t h <br />Agency signature: NA _required to be on site?- N a <br />Required Testing: Tank: NO Annual Annually Lines; No Annual Annually <br />Testing Permit Required Yes XX No <br />Test Type:— N/A <br />Test Date: <br />Test Performed By: Company Dialysis Company <br />Contact: James and Tamara Zimmerman <br />Phone <br />Tested By: license # <br />Test Results: Pass/ Fail <br />Remarks: Line and tank testinu are not required on a double <br />wall -,vstem oeg hiigngi, fgjjgws State Re:uiation <br />Monitoring System <br />Manufacturer: Veeder Root Model: TLS -2501 <br />Agency Requiring Certification ISan Joaquin Health <br />Agency Signature: NEA Required to be on site? No Date: gj2Q <br />Required Testing: XX Annual Semi-Azinual Annually <br />Testing Permit Required: -Yes XX No <br />Test Type: Annual Monitor 'Test <br />Test Date: - 9/20/95 <br />Test Performed By; Company Dialysis Company <br />Contact: James and Tamara Zimmerman <br />Phone: (800) 227-7879 <br />Tested By: James Zimmermau <br />Test Results; P a s s Pass / Fail <br />Remarks: Certified one ILS-25Qi consgie the panel, nrobe <br />and seaggr zage found--'-tQ J�e per manufart-jirprs <br />soecificahinnq- <br />Date of Next Test: <br />Ser. #22065 <br />