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Sacramento Equipment -M tenance Company Inc. <br />2M3 `onnie Drive <br />NEW <br />Sacramento, CA 95815 Calif. Contr. License #502377 <br />(916) 925-2716woe 58216 <br />PLIIPPoNT Data a for a to i 1 ie 1i641 <br />1. OWNER terepety ❑ <br />Tank(e) ❑ Nems <br />Address <br />2 OPERATOR - -- <br />3. REASON FOR <br />TEST C <br />W -ruin Fully) <br />4. WHO REQUESTED <br />TEST AND WHEN <br />5. TANK INVOLVED <br />Use additional on" <br />for nlanlfolded tank, <br />6. INSTALLATION <br />DATA <br />7. UNDERGROUND <br />WATER <br />S. FILL -UP <br />ARRANGEMENTS <br />C! <br />Nam <br />Rolls <br />Address <br />Identify by Dlreotbe capacity /suppBler <br />' /U 001 , „ - - _ <br />Location (qwr Fsb <br />(NEST p f <br />NOM Inlift dr, <br />Sf7SIi.� J2¢?in�" <br />R. of "I.I rot ,talc Top. 8W. Titeflq make. Lkop <br />�• moo' ta Fdka <br />any «AUtltetbn - <br />APPIVX Age <br />siph"" <br />U,6 <br />WINCh tank,? <br />d3tNVFlberglaa <br />i r7we11 <br />2-0241 <br />Depth to on water cobs a a» wn« ed« am Lok? <br />Oyel <br />Tanta to be Used hr. <br />oat.Affanoad by <br />Exna Product to 'top Off" nm tank tater. Now and rte b ?ramTileph«ne <br />Consider NO LNd <br />for aotiee «inquiry <br />SWM Walnne <br />T,lephpne <br />9. CONTRACTOR, <br />MECHANICS, <br />,];MECHANICS, <br />Cont actor <br />rrtrelead <br />10. OTHER <br />INFORMATION <br />OR REMARKS <br />Aaaaolw bbrmatbrn on <br />any Oeme .t>ow offlcwe «,hail b oe adorlaed when testing is In progreq « <br />I. TEST RESULTS Tests were made on the above tank systems In accordance with test rocedure$ <br />- as detailed on attached test charts with results as oilows prescribed for <br />Tank t wditotbn . :. r <br />TIM kkftfte <br />ftft TI <br />12 SENSOR 13. This Is to certify that these tank systems were tested on the date(a) shown. Those indicated as "Tight' meet the criteria established by <br />the National Fire Prot Association Pamphlet 329. <br />�r•'°h ", a Is ure r <br />•bssy of tie owner and/or operator of adssystem to immediately Was state and tical authorises of <br />any <br />OM, A implied hazard and the possibility of any reportable pollution to the erwirenment as a result of the kdicated failure 01 ads <br />system. Heath Consultants Incorporated and/or SACRAMENTO EQUI NT MAINTENANCE COMPANY, INC. does not <br />dterW e any rea�sibil« liability f« ant's of product 10 th vtronment. <br />serum <br />v C� <br />Coruscation, Tank Owner/Operato <br />Date <br />101 <br />