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Dynamic Back Pressure Test <br /> Afforda-Te$t 4162nd Street Z <br /> TP 201.4 <br /> Galt, Ca. 95632 <br /> (209)744-0112(800)524-9087 FAX(209)744-0116 Z Static Pressure.Decay Test <br /> TP 201.3 <br /> Owner/Contractor/Eng: TEST DATE:03-25-14 TIME: UST ® AST ❑ <br /> TECHNICIAN NAME: <br /> SITE NAME: PLAZA LIQUOR OASIS Felix R. Ramirez SJV45273934 ❑ PT ❑ Startup Test ® Compliance Test <br /> Address: 800 S CHEROKEE LANE AGENCY- SIYAP NORTH <br /> City:LODI CA 95240 1 declare, under penalty of perjury under the laws of the state Inspector: <br /> of California that based on information and belief formed <br /> Phone: 209-368-0127 after reasonable inquiry, the statements and information <br /> provided in the document are true, accurate, and complete. Present ❑ Not Present <br /> Contact: KAMAL <br /> Confirmation# 14-13258 TECH SIGNATURE: • <br /> Permit or Facility#N639-1-3 <br /> #DISPENSERS 1 DISPENSER Make: GILBARCO NOZZLE Make:HEALY PV Valve Make:HUSKY <br /> 4 TOTAL NOZZLES 4 1 Model: Model: 900 Model: 5885 <br /> MANIFOLDED: Yes ® No ❑ BALANCE ❑ ASSIST ® Assist Type:CAS ISD <br /> , Tank Tank2 Tank Tank TOTAL <br /> Initial pressure before testing-1.08 "we <br /> Fuel Grade 87 91 ALL <br /> #Nozzles per Tank 4 4 4 EQUIPMENT <br /> Actual Tank Capacity 12024 5010 17034 Decay: Blockage: <br /> Gasoline Volume 1401 1245 2646 Incline Manometer ❑ Incline Manometer ❑ <br /> Ullage(capacity minas Volume) 10623 3765 14388 Magnehelic Guage ❑ Magnehelic Guage <br /> Phase I System Type:2pt EVR Coaxial EVR EVR EVR Digital Manometer ® Digital Manometer ❑ <br /> Initial Test Pressure tmenes water)ito 2.0 Equipment Calibration Date: 02-03-14 <br /> 2 0 Drift Check End Value: 0 <br /> PSI @ 1 Minute pneheawarer) Nitrogen Intro.Point: PHASE i <br /> PSI @ 2 Minutes 2.0 Allowable Fill Time 2 sefm 9 MIN 27 SEC <br /> PSI @ 3 Minutes 1.99 <br /> . gp�4 Time 1:2 MIN 11 SEC <br /> PSI @ 4 Minutes 1.99 <br /> Final Pressure @ 5 Minutes(nuchal ware) 1.99 1 Time 2: <br /> MENTAL H EALTH 1.92 <br /> Allowable Final Pressure(CARB) Time 3: <br /> Liquid Removal Check,Dynamic Back <br /> ------ Pressure(if due),and Parts& <br /> _______ _______ _______ PASS Repairs Are Listed on Page 2. <br />