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CRISIi TANK TESTING Test Rei)or} <br /> 4'J <br /> 1 W. ALDER Test A ■ .�+ 1 i <br /> STOCKTON , CA 95204 Underground Storage Ta <br /> HORNER SYSTEM <br /> OWNER OF SITE <br /> T.��� <br /> ADDRESS OF OWNER ,/ 4AlC I.TY J,' STATEZ I P `/S2.5wo <br /> OWNER OF TANK <br /> ADDRESS OF OWNER CITY /;' STATE �°�' Z J P � <br /> NAME OF OPERATOR AT LOCATION 7- <br /> /A/Cl <br /> ADDRESS OF LOCATION ,�rte CITY_ � <br /> ,L/ / <br /> STATE C,9 Z I P 11 1 <br /> ��z yip <br /> NAME OF COUNTY �} r .lb_} <br /> TANK n 3 ON PLOT PLAN LOCATION. STORAGE ..SYSTEM.FtLLED; DATE TIME A20 <br /> DATE OF TEST TIME OF CLAY: -START Q boo FINISH Ojf/-� <br /> LENGTH OF TEST ,2 ,w-l_?^ I. AIR TEMPERATURE a _ <br /> DISCRIPTION OF TANK-CAPACITY/ 00 DIAMETER METAL ,�; FIBERGLASS <br /> TYPE OF SYSTEM- SUCTION SUBMERSIBLE X OTHER <br /> TYPE OF VAPOR RECOVERY SYSTEM <br /> TYPE OF PRODUCT BEING TESTED .lis_AZ. MEASRURED GRAVITY - COEFFICIENT �S` <br /> TEMPERATURE OF PRODUCT <br /> MEASURE? WATER IN TANK --o-- DEPTH OF TANK TOP FROM GROUND LEVEL <br /> DEPTH OF GROUND WATER ,y/ ,e/otE1,tI HI_ I GHT OF LIQUID LEVEL IN TEST STAND OR STAND PIPE Ar, <br /> AGE OF TANK AND LINES <br /> RESULTS OF TEST: CERTIFIED TIGHT: YES ){ NO IF NO EXPLAIN IN REMARKS BELOW <br /> LEAK RATE PER HOUR : + 5/_ <br /> REMARKS BY OPERATOR ,� 7-,!!5- 57-. <br /> A �✓ .v d <br /> 1. <br /> r c . <br /> a <br /> JAN C. ` NAME OF OPERATOR <br /> ENVIRCI Ei%TAL HEALTH <br /> FERPAIT/SERVICES S {G?JATURE OF OPE <br /> DATE //- - <br />