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Identify by Direction <br />TData <br />Brand/Supplier <br />Grade <br />Approx. Aga <br />E <br />CA for Tank System Tightnift Test <br />10,000 <br />Tanks to be filled hr. Date Arranged by -. <br />Name T <br />e <br />Extra product to "top off' and run TSTT. Now and who to provide? Consider NO Lead. <br />10,000 <br />VRTER <br />NEWF <br />PLEASE PRINT <br />EEI PETRO-Cim WE <br />1. <br />OWNER Property ❑ <br />QUICK STOP MARKETS, INC. PO BOX 5745, FREMONT, CA 94537 <br />Tank(s) ❑ <br />Name Andress RepresentatiJACK GRIFFITH <br />.415-657— <br />15 657—Name <br />I Cover <br />Figs <br />NameAddress Representative <br />T <br />2. <br />OPERATOR <br />CK STOP MARKETS INC. 1721 SOUTH CHEROKEE, IDDI, CA <br />4111 <br />2" <br />Name Address <br />DATA OF STORE <br />3. <br />REASON FOR <br />REGULATION GOVERNING UNDERGROUND STORAGE OF HAZARDOUS <br />11. <br />TEST <br />SUBICHAPTER 16 OF C11APTER 3 OF TITLE 23 OF THE CALI AI `? <br />Concrete, Black Top, <br />Earth, etc. <br />(Explain Fully) <br />Sin. Manifolded <br />Whim s <br />4. <br />WHO REQUESTED <br />OWNER <br />Name Title Company or Affiliation <br />Doe <br />Additional information on any items above. Officials or others to be advised when testing is in progress or completed. Visitors Of observant OVOOO* <br />TEST AND WHEN <br />during test etc. <br />Address <br />T <br />5. <br />WHO IS PAYING <br />FOR THIS TEST? <br />OWNER <br />Company, Agency or individual Person Authorizing Tito <br />T <br />Tank Identification Tight Leakage Indicated _ Date Tested <br />Bitting Address City State' <br />PIXRILM —NORTH TIGHT +.018 <br />Attention of: Order No. Other Instructions <br />Identify by Direction <br />Capacity <br />Brand/Supplier <br />Grade <br />Approx. Aga <br />/F' <br />6. TANK(S) INVOLVED ENORTH <br />E/W CENTER <br />10,000 <br />Tanks to be filled hr. Date Arranged by -. <br />Name T <br />ARRANGEMENTS <br />Extra product to "top off' and run TSTT. Now and who to provide? Consider NO Lead. <br />10,000 <br />VRTER <br />NEWF <br />E/W SOUTH <br />81000 <br />-WATER NEWFI <br />Company <br />10. <br />CONTRACTOR, <br />Location <br />I Cover <br />Figs <br />Vents <br />7. INSTALLATION SOUTH SIDE <br />EXPOSED <br />4111 <br />2" <br />WMIN <br />DATA OF STORE <br />NEST. TEST CONDUCTED WITH WATER IN ALL TANKS. <br />11. <br />OTHER <br />North inside driveway. <br />Rear of station, etc. <br />Concrete, Black Top, <br />Earth, etc. <br />Size. Titefill make. Drop <br />tubes. Remote Fills <br />Sin. Manifolded <br />Whim s <br />a <br />8. <br />UNDERGROUND <br />N/A DOUBLE WALL TANKS „ Is w otter ? <br />❑Yee ❑ we <br />WATER <br />Depth to the water table <br />9. <br />FILL -UP <br />Tanks to be filled hr. Date Arranged by -. <br />Name T <br />ARRANGEMENTS <br />Extra product to "top off' and run TSTT. Now and who to provide? Consider NO Lead. <br />Terminal or other contact <br />for notice or inquiry ' <br />Company <br />10. <br />CONTRACTOR, <br />MECHANICS, <br />— <br />— <br />any other contracts <br />involved <br />NEST. TEST CONDUCTED WITH WATER IN ALL TANKS. <br />11. <br />OTHER <br />INFORMATION <br />OR REMARKS <br />SAN JOAQUIN COUNTY. <br />Additional information on any items above. Officials or others to be advised when testing is in progress or completed. Visitors Of observant OVOOO* <br />during test etc. <br />Tests were made on the above tank systems in accordance with tort procedures prescribed for <br />12. <br />TEST RESULTS <br />t as detailed on attached test charts with results as follows: <br />Tank Identification Tight Leakage Indicated _ Date Tested <br />PIXRILM —NORTH TIGHT +.018 <br />--CENTER TIGHT +.005 <br />PR ED -- TIGHT —.002 <br />This is to certify that these tank systems were tested on the date(s) sham. Thaw indicsted as " <br />13. <br />CERTIFICATION <br />04-21-89 <br />the Fire Protection Asociation Pamphlet 329. <br />WILLIAM CAMPBELL PETRO—CHECK, INC. <br />Testing Contractor or Company. By: Signorina <br />414811816 2076 ACOMA STREET, SACRAVIENTID, CA T 815 <br />Technicians Address <br />Date <br />1819; 1972; 1854 <br />Serial No. of Then" <br />Sensor <br />