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Data Chart for Tank <br />PLEASE PRINT <br />I. OWNER PeopMy A411314- <br />Tsnklsl Nene <br />2. OPERATOR <br />3. REASON FOR <br />TEST <br />(Explain fully) <br />4. WHO REQUESTED <br />TEST AND WHEN <br />Addrea <br />Identify by Direction Capacity, BrunliPuppilair <br />5. TANK INVOLVED <br />Lbe additional "nes <br />for mandoided tanks <br />Tightness Tors <br />N®plHNliailtla <br />Company or <br />437-216j <br />Telephone <br />Apprex. AN Stal/Rber®lep <br />a <br />/® vxs it <br />a 9< <br />6. INSTALLATION <br />DATA <br />Lac~ Cove f"a Vena Siphoi« Pana <br />soaTV 61,1D ,) It/ Raj <br />0-r- 1.0-r C'�&r* "7 Z1\11Q Jac Krxt <br />North Inside drhsway, Concrete. SWA Tom. Ste. Tits"" more. Or�! Suction. <br />Nof statioto. Earth. amtubes. AA) Spa. Na which tetbT zl <br />w n. <br />7. UNDERGROUND <br />to tM water over the tw*? <br />WATER <br />Depth to as water, awe 150 t 13y. z Nd <br />8. FILL -UP <br />TWma to be fined ter. o Noma Telephone <br />ARRANGEMENTS <br />Extra pro" to 'Tap oW and nm dor ter. Mw and who to p v Ade4 CwdkW No Lao. <br />Tanning or other contact <br />1p Hopp er hWukY Company Name Telephone - <br />9. CONTRACTOR. <br />Faradiso Construction Company <br />MECHANICS, <br />any other contractor <br />Indeed <br />10. OTHER <br />INFORMATION <br />OR REMARKS <br />Add"beW information an dry item *Baud. Offiokle or othea to be aviwd when taekp N in ooprw or completed. Visitors or obevers preserd Off" test. ate. <br />TOM read. OW <br />wNh wlat <br />11. TEST RESULTS <br />n ae aft a <br />. <br />Tea ion T40 Leaps Indicated Date Tested <br />' <br />f / ® <br />e® F 67P <br />Z- <br />12. SENSOR <br />13. ra r a calivy sm was wrt syeftm was on par .' Owum Ties.. kwficided a W40 are by par <br />CERTIFICATION <br />3A <br />r <br />Technicians <br />oat* <br />PHILIP F. DELGADILLO Paradiso Construction <br />,. <br />122510940 TeCont..ote. <br />Serial Na. of Thermal <br />Celine.tioTest" 9220 G Street, Oakland, CA 94603 <br />Sensor <br />�,1 <br />a IRC M00IRF14F.4L, Adm <br />Cau"d<bn a _N /A PN682- <br />