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CRISP TANK TES <br /> P.-O . BOX 30487 �� <br /> 5ttcktvn , California JA�4 '1 0 1990 <br /> 00) 9311-1828 <br /> PERMIT <br /> TEST RE"-FORT <br /> OWNER OF SITE. <br /> a li'Ph fa <br /> AODRESS <br /> CITY_ i STATE,(:cjZ'IP 5 <br /> OWNER OF TANKS > <br /> ADDRESS • <br /> CITY STATE_Ljjjpa.� e, <br /> OPERATOR AT LOCATION <br /> ADDRESS ` <br /> ` CITY sTATEZIp �, <br /> MIME OF COUJTY , <br /> PLOT PLAN. AGE OF TANK - <br /> DESCRIPTION OF TANK: <br /> CAPACITY `c-) ,DIAMETER <br /> ,w, METAL FIBERGLASS. <br /> TYPE OF SYSTEM: SUCTION ,; SUBMERSIBLE : OTHER <br /> VAPOR RECOVERY SYSTEM? ; TYPE • <br /> PRODUCT BEING TESTED `�- --- <br /> � -- -- <br /> Pr. MEASURED [;FTAVITY� <br /> API SPECIEIC GRAVITY A 60OF <br /> yy �� pQDIIC T, TEMP. CQEC?( 3 <br /> STURAGEif �,- = . . . • . <br /> L _ DATES'4,7 c`3 , T Ir _� ' �( ' <br /> STARTD 0 3 � <br /> LENGTH OF TEST f <br /> f`FASUIIEU WATER IN TArd!< IlEIGIIT OF LIQUID LEVEL. <br /> • <br /> DEPTH OF GROUND WATER ' <br /> PSI AT TANK B0TT0M <br /> RESULTS OF TEST: • <br /> CERTIFIED TIG1117 -- YES <br /> ; .NO- IF NO EXPLAIN IN REMARKS. <br /> LEAK RATE F'ER IIUUj: + _ or <br /> r <br /> REMARKS BY OPERATOR <br /> NAME OF OPERATOR <br /> SIGNATUTE OF OPERATOR i <br /> DATE <br /> f' <br /> [.'y*qkj Y #•�' F`4'44.rTl <br /> je <br /> ' r <br />