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Crksp, TrnkTn Construe Company <br /> ompany <br /> Phone(209) 931-1828 Licensed <br /> Post Office Box 30481 s Insuted <br /> 200001 Colliornla 95213 <br /> **TEST REPORT** LICENSE #92-1248 <br /> KOWNER ;OF SITE t . LEO: A-'� F. CRISP <br /> : ,: 3 ria;, <br /> 4y ' <br /> ADDRESSs A, ITY: . . i.11.1, —LEZIP <br /> OWNER OF TANKS t r--J <br /> rf .i;, `r° ADDRESSt CITY: <br /> ZIP : <br /> h ;,,!.OPERATOR AT. LOCATION t <br /> , ADDRESS tCITY: ZIP: <br /> a 1 is COUNTY t TANK # AGE. GALLONS <br /> i <br /> .METAL FIBERGLASS( ) SINGLE WALLED(V-) DOUBLE WALLED( ) <br /> DIESEL(. ) UNLEADED( } PREMIUM UNLEADED() ( ) <br /> WA .+OIL( • } KEROSENE( ) AVIATION GAS( ) JET FUEL( } WATER( } <br /> SUCTION <br /> ( ` ) .: SUBMERSIBLE(Vj OVERSPILL CONTAINER— YES�Q NO( } <br /> SHEARVVALVE--YES NO( ) IN--LINE LEAK DETECTOR--YES(Y) NO( ) <br /> VAPOR RECOVERY SYSTEM--YES( ) NO V) *IF YES , PFIASE 1 ( ) PHASE 2 ( ) <br /> na ry <br /> `. NK�FILL DATE: TIME: <br /> ` ANii :,.TEST DATE s START., END:�LENGTIi OF 'i'E ST: <br /> __z �i •. <br /> i <br /> r 4.;TANK, OM TO GRADE. . . . , <br /> BOTTTEST LEVEL TO TANK BOTTOM_ , <br /> TANK TOP TO GRADE. . . . , . . GROUND WATER ABOVE TANK . . —� <br /> Y <br /> AMETER. . . . . . . . . . . . . . . �� PSI . . . . . . . . . . . . . . . . . . . . . . <br /> EST LEVEL' ABOVE GROUND. NET TEST PRESSURE. . . . . . . . <br /> *t;WATER 'IN TANK. . . . . . . . . . . API SPEC GRAY. . . . . <br /> Yri �a DEPTH , OR ,TAKING SAMPLE. TEMP . . ? <br /> tl . . . <br /> as ,ntTEMPERATURE PROBE DEPTH. API SPEC ,GRAV 60 ' .F. . . . r"r <br /> COEFICIENT OF EXP. . , <br /> i --YE <br /> TFIED :TIGHT S NO . . <br /> tf5 tiaM ziPeOk{i , L ( ) LEAK RATE PER/HR:fc J <br /> PRODOT, LINE TEST--PASS( FAIL( ) SUCTION( ) PRESSURE( ) <br /> CERTIFIED TIGHT--YES( ) NO( } LEAK RATE PER/HR:±_,.__ �J- <br /> ; i :COMMENTS t <br /> rDATEt SIGNATURE OF TESTER; • <br /> REV <br /> W92 <br /> f, <br /> -40 <br />��Af���i �t'i ti + • �. P.. J <br /> } t <br />