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416 2nd <br /> Gait CA 95632 <br /> LEAK <br /> AFF©RDA-TE$T (209) 744-0112 Street FAX (2 9) 744-011 6 LINE &EST EPO TCTOR <br /> CONTRACTOR/ENGINEER TEST DATE Ll <br /> SITE NAME lc�V�GUv�P�� � � v Cly k PHONE ( ) <br /> ADDRESS <br /> v� <br /> flepalNConstruction LOC TIONSKETCH�� snow No n <br /> Compliance <br /> nsurw ce A <br /> Escrow ac <br /> Make &Type of Pump or Dispenser <br /> Cover ver Lines <br /> Cloi-7e ri-)f p T7 n <br /> Approx Burial Depth r�) <br /> 0 c0 <br /> Weather 1l 44 41 <br /> Pressure SUctlOn SHOW STREETS,6LDGS,TANKS, ISLANDS, PIPING(IF KNOWN),PUMPS OR DISPENSERS <br /> LEAK DETECTOR FTA LEAK DETECTOR TEST INFORMATION calibrat, <br /> 10 PSI <br /> Opening I Element <br /> LD Serial Time In Test Leak Holding Pass I <br /> KEY TYPES NolProduct Key Number Resiliency Seconds Rate MLIMin PSI Metering PSI Fail <br /> A LD 2000 <br /> B LD 2000 E <br /> C FXI V <br /> D FXI DV <br /> E STPMLD <br /> F STPMLD- D <br /> G STPMLD- E <br /> H STPMLD - DIE Notes: <br /> CONTRACTOR LINE TEST RESULTS <br /> CERTIFICATION Tests were made on the line systems as noted in accordance with test procedures <br /> prescribed for as detailed on the test chart on Side 2 of this form with results as follows! <br /> Te h ' NimmO LINE IDENTIFICATION NET VOLUME CHANGE PER HOUR <br /> A�TROTITE CERT# U PASS FAIL / INCONCLUSIVE (QQyd'- <br /> 090993A0163 <br /> OTTL LIC#90-1143 u M PASS FAIL I INCONCLUSIVE Q <br /> Trainee: L� PASS FAIL / INCONCLUSIVE f� <br /> PASS FAIL / INCONCLUSIVE DODO <br /> EOUIPMENTPETRO TITE LINE TESTER <br />