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Tank:*e8tin & constructO n <br /> g company <br /> Phono (209)931.1828 A} - <br /> Post Cflpce Box 30467 4 <br /> J6uglkk vA.�-t t�'l+ } Licensed <br /> �. � <br /> S�toy,cWon„�Cali1omia 95213 V <br /> 93 C 2 P�1 ti: 00 �YIW'1Y �L���red <br /> ✓.7 .. � I <br /> **TEST REPORT** LICENSE #92-1248 <br /> -.OWNER OF..SITEs � t LEgNAi;'� E. CRISP <br /> 1 <br /> ADDRESS s `,,rr��I ZIP cl'6:. <br /> OWNER OF TANKS: <br /> _ ' ADDRESSs CITY: ZIP : <br /> t>.OPE <br /> RATOR AT LOCATION s ---�' <br /> ..t <br /> ADDRESSs <br /> CITY: <br /> >i ., --�-•-`—�- � ZIP- <br /> COUNTY <br /> IP:COUNTYt TANK #: AGE: GALLONS: <br /> a..,METAL(' FIBERGLAS( } SINGLE WALLED( DOUBLE WALLED( ) <br /> 3 <br /> ';'DIESEL{ UNLEADED( ) PREMIUM UNLEADED( } ( ) <br /> i WASTE OIL( ) • KEROSENE( ) AVIATION GAS( ) JET FUEL( ) WATER( ) <br /> r rSUCTION( ) SUBMERSIBLF (bL.) OVERSPILL CONTAINER--YES ) NO( <br /> .'SHEAR'YVALVE—WYES.{' } NO } IN—LINE LEAK DETECTOR---YESOO NO( ) <br /> YAPOR,,RECOVERY SYSTEM--YES( } NON) *I F YES, PHASE 1 ( } PHASE 2 ( ) <br />>� <br /> TANK' FILL DATES TIME: <br /> 'TANK. TEST DATES <br /> START: END:�LENGTFI OF TEST: ; <br /> ;,TANK- GRADE.' <br /> RADE <br /> • • • • TEST LEVEL TO TANK BOTTOM � .. <br />„ -+TANK=TOP` TO GRADE. . . . . . . GROUND WATER ABOVE TANK . . <br /> } ?.e <br /> DIAMETER - <br /> a }_ <br /> . . . . . . . . . . . . . . . .�� PSI . . . . . . . . . . . . . . . . . . . . . . <br /> rr 'TEST tLEVEL A. I'ABOVE GROUND. <br /> NET TEST PRESSURE . . . . . . . . <br /> 1t WATER `.IN TANK <br /> Y • . a . . r . . . . . API SPEC GRAV. . . . . . <br /> DEPTH FOR TAKING SAMPLE TEMP. . . . . . . . . ' <br /> . . . . <br /> , <br /> r}" .� ;' TEMPERATURE PRONE DEPTH. <br /> 't y •,''Y API SPEC GRAY C 601 F. . . . '� <br /> COEF I C I ENT OF EXP. . . . . . . . . -r' , <br /> CERTIFIED TIGHT-'-YESN) <br /> NO( , <br /> d; ( ( } LEAK RATE PER/HR:+ <br /> PRODU.0T: LINE TEST--PASS(V- } FAIL( } SUCTION( ) PRESSURE'yV\) <br /> CERTIFIED TIGHT--YEsW,) NO( } LEAK RATE PER/HR:+ /- <br /> �;{"`4 COMMENTS i <br /> DATE: <br /> SIGNATURE OF TESTER; <br /> }i y <br /> 1 <br />: } °;'• REVH',3/92 / <br /> 1 t + <br /> 1 ,a fl's , � • ' <br />