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111.1 Jill Champion <br /> Precision Tank Testing <br /> License No. 73848 <br /> o* DATA CHART FOR TANK SYSTEM TIGHTNESS TEST <br /> PLEASE PRINT <br /> 1. OWNER Property❑ <br /> Tank(s) <br /> Name Address Zip Representative Telephone <br /> ❑ <br /> Name Address Zip Representative Telephone <br /> 2. OPERATOR 7-11 # 20632 4672 DAVINCI DR. STOCKTON CALIF. <br /> Name Address Zip Telephone <br /> 3. REASON FOR REGULATION GOVERNING UNDERGROUND STORAGE OF HAZARDOUS SUBSTANCES <br /> TEST SUBCHAPTER 16 OF CHAPTER 3 TITLE 23 OF CALIFORNIA ADMINISTRATIVE <br /> (Explain Fully) <br /> 4. WHO REQUESTED <br /> TEST AND WHEN "a"" Title Company or Affiliation Date <br /> Address Zip Telephone <br /> Identify by Direction Capacity Brand/Supplier Grade Approx.Age Steel/Fiberglass <br /> 5. TANK INVOLVED NORTH SOUTH 10 ,000 BONITO PREMIUM STEEL <br /> NORTH SOUTH 10 , 000 TANKS MID GRADE STEEL <br /> Use additional lines NORTH SOUTH 10 , 000 LINES UNLEADED STEEL <br /> for m infolded tanks <br /> Location Cover Fills Vents Siphons Pumps <br /> 6. INSTALLATION FRONT CONCRETE 4" 2" RED <br /> DATA OF STORE JACKET <br /> TURBINE <br /> North inside driveway. Concrete.Black Top, Size,Titefill make,Drop Suction.Remote. <br /> Rear of station,etc. Earth,etc. tubes.Remote Fills Size,Manifolded Which tanks? Make if known <br /> 7. UNDERGROUND Is the water over the tank? <br /> WATER115" -/ WELL PAINT _ <br /> Depth to the water table from grade 1:1 yes 11 No <br /> 8. FILL-UP Tanks to befilled 1 9 O Ohr. 4/2 6/9 2 Date Arranged by <br /> Name Telephone <br /> ARRANGEMENTS Extra product to-top otr and run tank tester. How and who to provide? Consider NO Lead. <br /> TESTING rO- <br /> Terminal or other contact BONITO TANKS LINES SACRAMENTO CALIF. <br /> for notice or inquiry <br /> Company Name Telephone <br /> 9. CONTRACTOR, <br /> MECHANICS, <br /> any other contractor <br /> involved <br /> 10. OTHER SELF LEVELING STANDPIPE ALL <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 ❑ PETRO COMP ❑ QUICK CHECK 2000 <br /> 11 a. TEST RESULTS Tests were made on the above tank systems in accordance with test procedures prescribed for <br /> as detailed on attached test charts with results as follows: <br /> Tank Identification Tight Net Volume Change Per Hour Date Tested <br /> PREMIUM YES +. 033 4/26/92 <br /> MID GRADE YES — . 011 4/26/92 <br /> UNLEADED YES — . 006 4/26/92 <br /> 12. SENSOR <br /> CERTIFICATION <br /> 1/23/92 Technicians \ <br /> Data LW.CAMPBELL CHAMPION'S PRECISON TANK TESTING <br /> 418 Testing Contractor or Company. By: Signature <br /> Serial No.of Thermal certification. 92/1324 P.O. BOX. 13059 SACRAMENTO CALIF 95831 <br /> Sensor `- <br /> z j916-927-1557 1=800-660-9443 CALIF. <br /> Ceirtiacation0 .SACRAMENTO 1-800-949=9443 NEVADA <br />