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AFFORDA- $T <br /> 416�v Street Galt,Ca.95632 AR <br /> 209 744-0112 Fax 209 744-0116 AST TANK TEST <br /> Site: 3 RD i-�.ac lc fl,rr� l est Date: / <br /> Address: <br /> City: _: ; Equipment: <br /> Test Method Developed By: Tank Manufacturer {✓industry Standard Professional Engineer <br /> Other(Specify): y <br /> Test Method Uses: Pressure Vacuum Hydrostatic <br /> _ 0ther(Specify): (+ / ,,/ �^ <br /> Measuring Equipment Used for Testing: i:/*r r\ ;...•� 3 �' I�t[/ J—!I/vey E c1G% <br /> Tank# <br /> Tank# Tank# Tank# <br /> Tank Ca aci :: r;:Ij <br /> ... Tank Material: <br /> Product Stored:. <br /> Wait time between applying <br /> Pressure/Vacuuui/water and starting <br /> test: <br /> Test Start Time: �— <br /> Initial Readin (Ri): "> <br /> Test End Time: <br /> Final Readin (Rf): <br /> Test Duration: <br /> Chan einReadin Rf-Ri): <br /> Pass/Fail Threshold: <br /> Test Result: <br /> Was sensor removed for tasting) .�.1 <br /> Was sensor properly replaced after <br /> testing? <br /> Comments— (include information on repairs made to testing) <br /> Technician: Lyle D.Nimmo ICC#5249115-UT Exp. 07/01/09 <br /> Signature rfr > Date: <br /> L/ <br />