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Crisp Tank Testing & Comer ; truction Company <br /> Phone (209) 931-1928 licensed <br /> Post Office Box 30487 �� I�g� Insured <br /> Stocidon, California 95213 <br /> LICENSE #92--124$ <br /> ICON <br /> * <br /> ARD CR,SP <br /> T� <br /> DATE: - ) <br /> OWNER OF SITE: <br /> AI`DRESS: 6 l C)qCITY : . � , ZIPi�. <br /> OWNER OF TANK(S): kchta kFiliziln <br /> ADDRESS:JJs I_flr� �,. CITY: " ZIP: SJ <br /> f <br /> OPERATOR AT LOCATION: �r <br /> ADDRESS: ( C CITY : , ZIP: <br /> NAME OF COUNTY: AGE OF TANK: <br /> TANK#: CAPACITY : T6- GALLONS . METAL: FIBERGLASS:. <br /> SINGLE WALLED: DOUBLE WALLED: DIESEL: PREM. UNLEADED: <br /> UNLEADED: REGULAR LEADED: KEROSENE: WASTE OIL:: AVGAS: <br /> VAPOR RECOVERY--YES—NO-X-. IF YES, PHASE 1 : PHASE 2 : <br /> SYSTEM TYPE---SUCTION: SUBMERSIBLE: • INLINE LEAK DETECTOR--YES NO_ <br /> SHEAR VALVE--YES NO_,X_. OVERSPILL CONTAINER--YES NO . <br /> TANK FILLED--DATE: TIME: <br /> TANK TESTED--DATE: START: FINISH:� �jQ <br /> LEGNTH OF TEST: HOURS . MINS . <br /> TANK BOTTOM TO GRADE: ' J " , TANK TOP TO GRADE:_"" . DIAMETER : <br /> TEST LEVEL ABOVE GRADE : WATER IN TANK : "' . <br /> DEPTH FOR TAKING SAMPLE : 21-6. . TEMPERATURE PROBE DEPTH: _7c� " . <br /> TEST LEVEL TO TANK BOTTOM: _ GROUND WATER ABOVE TANK c�. <br /> PSI : ,Q,2L. NET TEST PRESSURE . <br /> **RESULTS OF TEST** <br /> CERTIFIED TIGHT--YES:NO <br /> LEAK RATE PER HOUR: + _ (� <br /> SIGNATURE OF TESTER : [ ' <br />