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416 2nd Street Galt CA 95632 LINE & LEAK DETECTOR <br /> /AFF®R®A-TE$T (209) 744-0112 FAX (209) 744-0116 TEST REPORT <br /> CONTRACTOR/ENGINEER TEST DATE <br /> SITE NAMEpL ) I� F / d ��r�, �c: ,� PHONE ( ) <br /> r <br /> ADDRESS �T-Z 7j L �yf- {%(� <br /> c' <br /> Repair/Construction LOCATION SKETCH WZ Show North <br /> Compliance <br /> Insurance <br /> atE <br /> Escrow <br /> Make &Type of Pump or Dispenser <br /> Cover Over Lines <br /> C-1.(> �-I ,, V ,i',= x', <br /> Approx Burial Depth tlo 0 Q <br /> t <br /> Weather <br /> (y/ — V/ _ <br /> Pressure SUCtiOrl ISHOW STREETS, BLDGS,TANKS, ISLANDS, PIPING(IF KNOWN), PUMPS OR DISPENSERS <br /> LEAK DETECTOR FTA LEAK DETECTOR TEST INFORMATION Caiibrat <br /> 10 PSI <br /> Opening I Element <br /> LD Serial Time In Test Leak Holding Pass 1 <br /> KEY TYPES No/Product Key Number Resiliency Seconds Rate ML/Min PSI Metering PSI Fail <br /> A LD 2000 ) ';1. �/ % `' `i I✓ - ' <br /> B LD 2000E <br /> C FXI V <br /> D FXI DV <br /> E STPMLD `I <br /> F STPMLD - D <br /> G STPMLD- E <br /> H STPMLD - D/E 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 h1 ician:,Lye . Nimmo LINE IDENTIFICATION NET VOLUME CHANGE PER HOUR <br /> -,7JROTITE CERT# -`� A S FAIL / INCONCLUSIVE <br /> 090993AO163 <br /> OTTL I_IC#90-1143 ''/ j PASS /) FAIL / INCONCLUSIVE <br /> Trainee:0144 t, r-4-(416� /'j i`�o /l)r!;�' ? PASS / FAIL / INCONCLUSIVE <br /> PASS FAIL / INCONCLUSIVE <br /> EQUIPMENT PETRO TITE LINE TESTER i <br />