Laserfiche WebLink
I Lb I INU �JMWION ,U . <br /> 30407 LICENSED �''. <br /> STOCKTON, CA 95213 FEB 1g�# INSURED ' ' <br /> (2U9) 93 I- 182U � <br /> FAX (209) 465-3006 ENVIRONMENTAL HEALTH <br /> I ERVICES ------- <br /> *TEST ���RT* * "LICENSE 91248 <br /> h� <br /> OWNER OI' SI'1'E:_�� LEONARD E. CRISP��x���C,, -- ---------- --__ - --- ---____------- <br /> ADDILE;SS:_u._��.�r1_L�=�1� ���� ---- CITY: U ,-- -----.._--- _ ZIP: -- <br /> OWNER OF TANKS:--- ---------------- ----------- — ---- - ---- - <br /> CITY:.------------ ---- ZIP;__ ---- <br /> OPERATOR AT LOCATION:--- <br /> ADDRESS:--- --- <br /> COUNTYL� <br /> V1-n-) ___ TANK#:-Z-- AGE:----- GAI.LONS:-4 r <br /> MRTAIV--) FIBERGLASS( ) SINGLF. WALLED( ) DOUBLE WALLED( ) <br /> DIESEL( ) UNLEADED { ) PREMIUM UNL. (� _ <br /> SUCTION( ) SUBMERSIBLEN-) OVERSPILL CONTAINER*LYES( ) NON-1) <br /> SHEAR VALVF*'YES( ) NO( ) IN-LINE LEAK DETECTOR*'YES( ) NOV-) <br /> VAPOR RECOVERY SYSTEM'*YES( ) NO(Y-) 1F YES, PHASE H ) PHASE [I( ) <br /> TANK FILL DATE: '- TIME:-1 -Q—t) <br /> TANK TEST DATE: 8 �t START:_____ FND: <br /> LENGTH OF TEST:' �h � <br /> TANK BOTTOM TO GRADE.....—jLb--" TEST LEVEL TO TANK BOTTOM.....`" <br /> TANK TOP TO GRADE............ " GROUND WATER ABQVE TANK..... <br /> DIAMETER..............................__��_„ PSI.,.. <br /> 'I'E5'I' LEVEL ABOVE GROUND.. NET TEST PRESSURE. ..... : ..... .c �� <br /> WATER IN TANK............ ............... <br /> API SPECIFIC GRAVITY................. _ <br /> DEPTH FOR TAKING SAMPLE... TEMPERATURE............... <br /> TEMPERATURE PROBE DEPT If....__" API SPECIFIC GRAVITYP fig(;' F......—t(o - <br /> COEFFICIENT OF FXP........................CCY- <br /> Aoc 46 <br /> LEAK RATE PER/HR:+-------/A434-7— <br /> CERTIFIED TIGHT: YF.S(V-) NO( ) <br /> PRODUCT LINE TEST: SUCTION( ) PRESSURED) <br /> LEAK RATE AER/HR: <br /> CERTIFIED TIGHT: YES( ) NO( ) <br /> 1)A E; >_ 1 SIGNATURE OF TESTE <br /> COMM <br /> ?w��� <br />