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Tank and Monitor Suratuary <br />Location Pacific Bell Gco/P"I UE -058 <br />Address 1 n R 1 ?f -h- -qf- CLLC: TRA Q 11 <br />City Tr acv T" # 3103 <br />County, $all lQaauin Tu:LPcn-njI# Dot-no-t-t=tj hy tp-r-h <br />Zip EXp"6QQ Date <br />losp"doo Record <br />Uodcrgrouud Storugc Tank <br />Tvik Sizc: 2, QQQPmduct CliggggI Fuel level Ca, icstI257-.24 41.0 Monitor 41.0 Stick <br />Agency mquiii g Conifi"6= ado jQdqMjO H alth <br />Agency sigutWC. U I L --- —rvqu4vd to bc,-,u site?--aQ— <br />Roquira Testing: Took: no AV;;Zl &an uaj I y U00; no AJVIuW ArwuWly <br />To4ing Permit Rquircd Yes x No <br />Test Type; N I a <br />TosiDatc: 8-29-96 <br />Tc -g Performed By. CQMWY See below <br />Contact: <br />Phone NL�;nb< r <br />Tc>ie4 B), license <br />NIQuitoring System <br />Mua4cp4mr: Veeder Root Model: TLS -350 <br />Agency Requiring Ccr%ifiQa6on Same as above <br />Agency Signature: N 11 A Required to be on site? .. no <br />Required Testing: xx Ar.1 t.4 Sen -Annual Annually <br />Testing Permit Rcq": Yes x No <br />TcstTypc; AUaijaj Montior Test Date: <br />Test Peiforme-d By; Company, DIALYSIS COMPANY <br />Contact. James or Tamara Zimmerman <br />Phone. 800 227-7879 - <br />Tested S) James Zimmerman <br />TcsiRcsults: pass Pus / Fail <br />RCMUk$. RP-nI;;r-tztj nwi=r 1 i ahi- Tinnn -q-rriN,-Al fnnnrl <br />Lemntp disnI y Setiip in wArninc-T Anij --nfi-wArP in -.7nrnin <br />2QwPrPH dnwn cvqtPm- Anrl rt=nrnq-rAmmAH- qVCi-PM A. <br />Dnnakl nrnhdz and cimn-cznra, ;;rp nnw fiin,(-f-innina-a-c--DR-r--maniifacturers <br />specifications. <br />Date of Next Test:. a-27 <br />Serial: 41232503905001 <br />