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CRISP TANK TESTING Test Rep� r� <br /> 140 "W. ALDER <br /> STOCKTON, CA 95204 Underground Storage Tangy <br /> HORNER SYSTEM <br /> OWNER OF SITE <br /> AUDRESS OF OWNER %3�6 ,!! /�. ,4q C I TY _STATE C,4 Z I P y5.2 <br /> OWNER OF TANK -T T -T-�cyc -„t'C, -- <br /> ADDRESS OF OWNER 1/3 9d ,cl• y 9`9 C I TY^ _��, STATE _Z 1 P g� zoo <br /> NAME OF OPERATOR. AT LOCATION <br /> ADDRESS OF LOCATION X1 �/;t gq C I TY Lid: STATE °.} Z I P 5�52 510 <br /> NAME OF COUNTY ,,/ <br /> TANK # / ON PLOT PLAN LOCATION. STORAGE SYSTEM FILLED; DATE TIME /Som <br /> DATE OF TEST//-/Z TIME OF DAY: START `f. —FINISH 12 417 <br /> LENGTH OF TEST._�1�R ,,I,) AIR TEMPERATURE `y <br /> DISCRIPTION OF TANK-CAPACITY po DIAMETER 7,5-” METAL Y FIBERGLASS <br /> TYPE OF SYSTEM- SUCTION SUBMERSIBLE ,t� OTHER <br /> TYPE OF VAPOR RECOVERY SYSTEM 4 _ <br /> TYPE OF PRODUCT BEC.I NG TESTED [/A/ ,c p," MEASRURED GRAVITY SEs. S COEFF I C l ENT,cc S <br /> TEMPERATURE OF PRODUCT /,5-0 <br /> MEASURED u:A T ER IN TANK -0 — DEPTH OF TANK TOP FROM GROUND LEVEL <br /> DEPTH OF GROUND WATER uA.),e.vae.�,�1 HEIGHT OF LIQUID LEVEL IN TEST STAND OR STAND P I PE�. <br /> AGE OF TANK AND LINES4")/<.v'v-1�11✓ _ <br /> RESULTS OF TEST: CERTIFIED TIGHT: YES t' NO IF NO EXPLAIN IN REMARKS BELOW <br /> LEAK RATE PER HOUR: <br /> REMARKS BY OPERATOR <br /> r j <br /> JANO ' <br /> ENVIROIIMENTAL HEALTH NAME OF OPERATORZ=4/,4,/zZ <br /> F ERMIT/SERVICES <br /> SIGNATURE OF OPERATOP <br /> DATE <br />