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m� <br /> fforda-Te t 4162"d Street Phone: (209)744-0112 LINE & LEAK DETECTOR <br /> Galt,Ca 95632 Fax: (209)744-0116 TEST REPORT <br /> a# arch 0oftcom.net <br /> ,i <br /> jt.. <br /> v J <br /> CONTRACTOR/ENGINEER TEST DATE 8/11/11 <br /> SITE: LOVE'S TRUCK PLAZA SEF 19 2011 <br /> 1553 COLONY RD. SAN JOAi.U;."A Co i y <br /> RIPON, CA 95366 ENW,-)0i�k,,,E ;,AL <br /> HEALTH s;DEPARTMEN7 <br /> Repair/Construction LOCATION SKETCH Show North <br /> ® Compliance ❑ Owners Request <br /> Insurance 0 Escrow SHOW STREETS,BLDGS,TANKS,ISLANDS,PIPING(IF KNOWN),PUMPS OR DISPENSERS <br /> Other GAS SIDE <br /> Make&Type of Pump or Dispenser C- STORE O <br /> FE PETRO/ GILBARCO O <br /> Cover Over Lines <br /> CONCRETE 0 O 0 <br /> Approx Burial Depth <br /> 5-7 FT. l� <br /> Weather <br /> SUNNY, WARM D CI <br /> Pressure Z I Suction <br /> Calibrate <br /> LEAK DETECTOR FTA LEAK DETECTOR TEST INFORMATION 10 PSI <br /> Opening Test Leak I Element <br /> KEY TYPES No/ LD Serial Resiliency Time In Rate Holding Metering Pass/ <br /> Product Ke Number Seconds ML/Min. PSI PSI Fail <br /> A LD 2000 <br /> B LD 2000 E 87 B 240 12 189/3 35 1 26 PASS <br /> C I FXI V <br /> D FXI DV 91 B 150 17 189/3 20 26 PASS <br /> E STPMLD <br /> F STPMLD — D DIE N G 850 4 189/3 33 26 PASS <br /> G STPMLD — E DIES G 490 4 189/3 28 25 PASS <br /> H STPMLD—D/E Notes: <br /> CONTRACTOR <br /> CERTIFICATION LINE TEST RESULTS <br /> Technician: Tests were made on the line systems as noted in accordance with test procedures <br /> Zane A.Nimmo prescribed for as detailed on the test chart on Side 2 of this form with results as follows: <br /> LINE IDENTIFICATION NET VOLUME CHANGE PER HOUR <br /> PETROTITE CERT. 87 OCT ®PASS ❑FAIL ❑INCONCLUSIVE +.0040 <br /> #:CCA0202112304R <br /> ICC# 5263322 UT []PASS ❑FAIL ❑ INCONCLUSIVE <br /> OTTI.License#: 04-1676 <br /> Trainee: 91 OCT ®PASS ❑FAIL ❑ INCONCLUSIVE +.0040 <br /> DIESEL ®PASS []FAIL ❑ INCONCLUSIVE ,0000 <br /> EQUIPMENT: PETRO TITE LINE ❑PASS ❑FAIL ❑ INCONCLUSIVE <br /> TESTER <br /> SJ C �- <br />