COMPLIANCE INFO_1986-2005 - Laserfiche WebLink

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7. _ a a Data Con for Tank SystemTight est weoe #a_ Siphones ®b Q Which tanks 7 Pumps j?6yJfi Suction, Remote, Make it known UNDERGROUND WATER Depth to the Water table R 1 �q nn v 1 n te c p Station # PLEASE PRINT FILL -UP ARRANGEMENTS Tanks to be filled hr. Date Arranged by Name Telephone Extra product to "top off" and run TSTT. How and who to provide? Consider NO Lead. 1. I, 1 14 IN 10 9. 4111111ealea OWNER Property _ _ for notice or inquiry Tank(s) ❑ Name Ad reaS- Representati e _ T to ho / CONTRACTOR, Name Address— Representative Telephone 2. OPERATOR 3 ,CA _ Name Address 11. ayo Telephone 3. REASON FOR INFORMATION TEST 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. (Explain Fully) TEST RESULTS Tests were made on the above tank systems in accordance with test procedures prescribed for r Tlt4' as detailed on attached test charts with results as follows: Tank Identification Tight Leakage Indicated Date Tested 4. WHO REOUESTED %! if ✓* A. I-- n A t ! *T-- ✓ TEST AND WHEN Name title Company of Affiliation Date Address Telephone 5. WHO IS PAYING# FOR THIS TEST? ompany, Ageney or tndiv duet Person Authorizing Tide Telephone 5i1119 Address City State yip Attention of: Order No. Other instructions Identify by Direction Capacity Brand/Supplier I Grade Approx. Age Steel/Fiberglass 6. TANK(S) INVOLVED — n : r ,_ - • I -,,,_, . 7. INSTALLATION DATA Location /7o27-11 o f= Co/'jtP,( 'r North inside driveway, Rear of station, etc. Cover ek-P05CC Concrete, Black Top, Earth, etc. fills y Size, Titefill make, Drop tubes, Remote Fills Vents 3 Size, Manifolded Siphones ®b Q Which tanks 7 Pumps j?6yJfi Suction, Remote, Make it known UNDERGROUND WATER Depth to the Water table R 1 �q nn v 1 n te c p Is the water over the tank? 0 ria No 9. FILL -UP ARRANGEMENTS Tanks to be filled hr. Date Arranged by Name Telephone Extra product to "top off" and run TSTT. How and who to provide? Consider NO Lead. Terminal or other contact for notice or inquiry Company - Name Telephone 10. CONTRACTOR, MECHANICS, any other contractor involved 11. OTHER tin H/9,212 INFORMATION OR REMARKS 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. 12. TEST RESULTS Tests were made on the above tank systems in accordance with test procedures prescribed for r Tlt4' as detailed on attached test charts with results as follows: Tank Identification Tight Leakage Indicated Date Tested L_ %! if ✓* A. I-- n A t ! *T-- ✓ w (T J This is to certify that these tank systems were tested on the date(s) shown. Those indicated as "Tight" meet the criteria established by CERTIFICATION the National Fire Protection Asociation Pamphlet 329. (� ` Do. /�7 _Jim Wilkerson Sa r me o Equipment Mai ce a oatss Testing Contractor or Company. By: Signature nc e io£�a _Lee Reeves 2533 Connie Drive -Sacramento - Ca. Serial No. w Thermal Technicians Son" Jeff Palmer Contractor li CenseAddress . #502377-C61