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CONTRACTOR/ENGMEER <br />ORDERING TEST <br />POB 36 26515 N. SACTO.BL. AVE &LEAK DETECTOR <br />THORNTON, CA. 95686 TEST REPORT <br />(209) 794-0102 (800) 524-9087 <br />TEST DATE <br />SITE: <br />LOCATION SKETCH <br />SNOW STREETS, BLDGS, TANKS, ISLANDS; PIPING F KNOWN), PUMPS OR DISPENSERS <br />OPERATOR r5 Stt�a}}tion# <br />OWNER <br />SITE ADDRESS / Jr�j e 0 1O " c G`` <br />ADDRESS <br />u <br />LINRs)-LEAK DET. <br />PHONEo'�il ���� y b �� <br />PHONE ' <br />REASON FOR TEST <br />17lrr�Q� PSj` <br />LOCATION SKETCH <br />SNOW STREETS, BLDGS, TANKS, ISLANDS; PIPING F KNOWN), PUMPS OR DISPENSERS <br />LWE(s) ONLY <br />I <br />TANK(s)-LINE(S <br />LINRs)-LEAK DET. <br />TANK(s)-LINE(s)-LEAK DET. <br />MAKE & TYPE OF � <br />PUMP (( <br />OR DISPENSER yi (jam <br />COVER OVER //•� <br />LINES 1. o I p <br />APPROX BURIAL' <br />DEPTH <br />WEATHER Com% <br />PRESSURE <br />Y <br />SUCTION <br />LEAK DETECTOR <br />FTA LEAK DETECTOR TEST INFORMATION Calibrate <br />10 PSI <br />E <br />y <br />TYPES: <br />No. <br />LD <br />KE <br />Serial <br />Number <br />Resiliency <br />Opening <br />Time <br />In Seconds <br />Test <br />Leak Rate <br />MLIMin <br />Functional <br />Element <br />Holdin PSI <br />etering <br />PSI <br />Yes/ <br />No <br />Product <br />XLD P!63 <br />l R%� <br />/ J <br />BFLD (XL MODEL)PIN <br />C <br />PLD P/ <br />XLP P/ <br />DLD P/N 116017-5 <br />BFLD P <br />OTHER nt-f <br />1 <br />Notes <br />CONTRACTOR <br />CERTIFICATION <br />LINE TEST RESULTS <br />TESTS HERE AIADEON 7TIELINE SYSTEMSASNOTED INACCORDANCE RTTH TEST <br />PROCEDURES PRESCRIBED FOR AS DETAILED ON 771E TEST CHART ON SIDE 2 <br />OF7711SMPM{iTTIIRESULTSASMLLORS. <br />TECHNICIAN.^LYLE.D. NINVIMO <br />sIQNATURE -l! y { /f y <br />DENTIFICATION NET VOLUME C ANGE PER HOUR <br />PETROWI7 E CERT. # 090993AO163PASS/)/ <br />LIC a 91-1143.�,t,Nane <br />F <br />FAIL / INCONCLUSIVEUfTL <br />PASS / FAIL / INCONCLUSIVE <br />T�S�.n= <br />l� <br />(PAS FAIL / INCONCLUSIVE <br />FEATURING PETR TOTE <br />LINE TESTER <br />PASS. / _FAIL / INCONCLUSIVE <br />