Laserfiche WebLink
�F�®®®/"i��� � 416 2nd Street Galt CA 95632 Spill Bucket <br />f� (209) 744-0112 (209) 744-0116 FAX Test Report <br />TEST DATE <br />SITE NAME z 01/C S PHONE( 209 <br />ADDRESS /1 � 3 Co LOn! �z .moo'9 o CONTACT: <br />t <br />Inspector: /2,g� �- G14IC-,- i 7- <br />3. SPILL BIJCKF,T' TF.gTTN(;' TNF(lRMA rYnNJ <br />Present ) / Not Present <br />Test Method Used: �lydrostatic ❑ Vacuum ❑ Other <br />Test Equipment Used: T,19- a� ZU <br />Equipment Resolution: <br />Identify Spill Bucket (By Tank <br />Number, Stored Product, etc. <br />1 1 <br />2 S Nv <br />8 y7 <br />3 <br />4�/�S �l L <br />Bucket Installation Type: <br />❑ Direct B �' <br />&Contained in Su <br />El Direct Bury <br />KContained in Sum <br />❑Direct Bury <br />Contained in Su <br />❑Direct Bury <br />�V Contained in Sum <br />Bucket Diameter: <br />I <br />I <br />Bucket Depth: <br />Z <br />Wait time between applying <br />vacuum/water and start of test:— <br />r <br />Test Start Time (TI): <br />a <br />v <br />�.'(jo <br />o� <br />`%o <br />Initial Reading (RI): <br />O L4 <br />b <br />2 3 <br />t 3 <br />Test End Time (TF): <br />00 <br />/0 crp <br />o : o <br />/O _ vD <br />`n�� <br />Final Reading (RF): <br />Test Duration (TF — Tj): <br />2 <br />2 <br />(e - <br />Change <br />Change in Reading (RF - RI): <br />Pass/Fail Threshold or <br />Criteria: <br />1 � `SOci�''.:'�' - +.r�f 4r r,�!�. 4'"� <br />��''�wJx�'!r6 <br />4.;. ,,, :i ' i.�r: ! 1 b'-�(�" t "1' � .', "4 <br />�'i�ilt .� ;' 4;WP aCf}{ d � . t r • ,u <br />,� , ,��>•, n � � � <br />� <br />r '� t r� � <br />M, , a <br />Comments — (include information on repairs made prior to testing, and recomrnended follow-up for failed tes Rss, <br />Test Water:Taken with tester Left on site <br />I hereby certify that all the information contained in this report is true, <br />accurate, and in full compliance with legal requirements. Technician: <br />Signature <br />ICC #: <br />OTTL #: <br />Zane A. Nimmo <br />5263322 -UT <br />04-1676 <br />