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1'OH 16 26515 N. SAC'TO. BL. <br />[��� •� � . TIIORNTON, CA. 95686 <br />209 794-0102 (800)524-9087 <br />CONTRACTOR(ENGINEER <br />ORDERING TEST <br />SITE: <br />OPERATOR e 5' <br />SITE ADDRESS 15_1')_ <br />PHONE <br />REASON FOR TEST <br />LINE(s) ONLY 'TANK(s)-I.IN[i(s <br />�( <br />LMS) -LEAK DET. <br />L� TANK(s)-LINE(s)-LEAK DET. <br />MAKE R TYPE or. rt mn <br />COVER OVER / <br />AITROX "M", f <br />DEPTH V <br />WEATHER <br />SUCTION <br />NE & LEAK DETECTOR <br />TEST REPORT <br />TEST DATE 6 -/ 7 — d <br />4' '2`0 D`2 <br />OWNER <br />ADDRESS <br />PHONE <br />LOCAVION SKETCH <br />Pe Y4IC94 <br />OR <br />LEAK DETECTOR <br />r IA LEAK UIJTEUTOR "PEST INFORMATION `MPMe <br />CLASS / <br />FAIL / <br />INCONCLUSIVE <br />(PASS / <br />FAIL / <br />INCONCLUSIVE <br />OPSI, <br />z <br />No. <br />LD <br />Serial <br />C % <br />U en ng <br />Test <br />wn <br />d <br />Ya/t <br />y rIPEs <br />Ptodwd <br />KrT <br />Number <br />Resiliency <br />Time <br />beak Rate <br />Element <br />RSI <br />No <br />In Sscondi <br />Holl AS <br />t`, <br />XLDPM 116036-5 <br />1 l'i�o <br />r <br /><4o06 z <br />`��.. � <br />FLD (XL MODEL <br />P/M 116039-5 <br />PLD P/N ] 16030-5 <br />'' �,�• <br />�'y <br />(�/(� 'j Df�iS` I <br />/ ,J 5 <br />CD <br />� r <br />! oc <br />XLP PIN 116035-5 <br />DLD P/14116017-5 <br />a ; <br />BFLD PIN 116012-5 <br />amR <br />l70`� <br />aaS <br />�- <br />CONTRACTOR <br />CERTIFICATION <br />TECIINIUM: LYLE D. NIMMO <br />RIONA7l/Rls , . <br />n <br />PETRO'VI'I'E CERT. 0 090993AO163 <br />OfTL LIC N "-1113 <br />LINE TEST RESULTS <br />7 FC7:C nFRF AMIE ON 77LF, IJNF SIS7EUSAS N07W BV ACCORDANT W17N 7= <br />/'RrN.'F1)(J/?MVPREWR1BM)MR AS DETAILED ON7NgMrCHARTONSOff2 <br />LINE IDENTIFICATION <br />NET VOLUME QUNGffPGR! <br />CLASS / <br />FAIL / <br />INCONCLUSIVE <br />(PASS / <br />FAIL / <br />INCONCLUSIVE <br />p� <br />. PAS / <br />PASS. I <br />FAIL / <br />-FAIL / <br />INCONCLUSIVE <br />INCONCLUSIVE <br />C % <br />