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Data Chart for Tank System 0Tightness Test <br /> ., ., <br /> PLEASE PRINT pETAd <br /> ONECK INC. <br /> 1. OWNER Property ElDAVE LAMB Telephone <br /> ❑ <br /> OM epreNntahYe UNIVERSITY DRIVE Sacramento, C� T.l.phon. <br /> Tank(s) Address Repnsentatire <br /> Name <br /> Seven-Eleven (7-11 ) 4627 Davinei Road Stocktonif CA Telephone <br /> 2. OPERATOR Name Addtess <br /> 3. REASON FOR �� ING GOVERN ��� <br /> TEST SUBCHAPTER 16 OF CHAPTER: 3 TITLE 23 OF THE CALIFORNIA ADMINISTRATIVE CODE. <br /> (Explain Fully) <br /> 4, WHO REQUESTED OWNER Title Name Comwny or Affiliation Date <br /> TEST AND WHEN Telephone <br /> ddress <br /> r��r������t+ppYY1VER A <br /> lJTitle Telephone <br /> 5. WHO IS PAYING Company.Agency Or Individual Person Authorizing <br /> FOR THIS TEST? City State zip <br /> Billing Address <br /> Attention at: <br /> Ober No. Other InstructionsBrand/SuDPli+r Grads Approx.Age Steel/Fiberglass <br /> Identify by Direction Capacity <br /> 6. TANKS) INVOLVED WEST 10,000 <br /> AR <br /> Location Cover Fills <br /> Vents Siphons Pumps <br /> 7. INSTALLATION FRONT NORTH — TURBINE <br /> DATA LOT <br /> CONCRETE 411 211 NO <br /> Suction,Remota. <br /> North inside driveway, Concrete.Black Top. Size,Tilefill make,Drop Size.Manllolded Which tanks? Make if known <br /> Rear of station.etc. Earth.etc. tubes.Remote Figs <br /> I$the water over the tank? <br /> 8. UNDERGROUND BELOW TANKS ❑ yes ❑ No <br /> WATER Depth to the Water table <br /> Tanks to be filled hr. Date Arranged by- Name Telephone <br /> 9. FILL-UP <br /> Extra product to"top CIand run TSTT. How and who to provide? Consider NO Load. <br /> ARRANGEMENTS <br /> Terminal or other contact <br /> for notice or inquiry Name CompanyTelephone <br /> 10. CONTRACTOR, — <br /> MECHANICS. <br /> any other contractor <br /> involved <br /> 11. OTHER <br /> INFORMATION <br /> OR REMARKS <br /> Additional information on any items above.Offieiais or others to be advised when testing is in progress or completed.Visitors or observers presort <br /> during test etc. <br /> Tests own made on the above tank systems in accordance with test Procedures prescribed for 1r0 jl ` <br /> us as follows: <br /> 12. TEST RESULTS as detailed on attached test charts with resu <br /> Tight Leakage Indicated Date Tested <br /> Tank Identification g ?JUNE 18, 1988 <br /> TIGHT NONE <br /> This is to certify that these tank systems wen tested on the date($)shown.Those indicated as"Tight'mese the criteria established by <br /> 13. CERTIFICATION the National Fin Protection Asociation Pamphlet 329. <br /> JUNE 18, 1988 Bill. Campbell PETRO-CHECK, INC. <br /> Testing CONNctol or Company y Signature <br /> Data <br /> 1819 414811816 271 OPPORTUNITY ST SUITE C SACRAMENTO CA 95838 <br /> Aaeress <br /> Signal No.of Thermal Technicians <br />