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AFFORDA-TE$T Site Name: PLAZA LIQUOR OASIS <br /> 416 2nd Street Address:800 S CHEROKEE LANE Q = <br /> Galt, CA 95632 City: LODI CA Zip: 95240 —~i <br /> (209) 744-0112 Fax (209) 744-0116 Facility Permit #: N639-1-3 W v <br /> Date:03-25-14 Time: > Z <br /> Technician: Felix Ramirez a <br /> District Cert #: 5273934 Exp. 2014 W •--r w <br /> Healy Cert #: 2866213761 Exp. 2014 ! , = a <br /> V Z w <br /> 00 <br /> Digital Manometer Calibration Date: 02-03-14 W <br /> HEALY TEST FORM w <br /> Clean Air Separator Pressure Performance Test Nozzle Bag Test <br /> Fuel Grade: <br /> Nozzle Type: <br /> Initial Vacuum/ Pressure prior to test ❑ - Z + <br /> #1 #7 #13 #19 #25 #31 <br /> 1. Initial Vacuum / Pressure (W.C.) 2.0 <br /> 2. Vacuum/ Pressure after 1 minute, inches of water: 2.01 #2 #8 #14 #20 #26 #32 <br /> 3.Vacuum/ Pressure after 2 minutes, inches of water: 2.02 <br /> #3 #9 #15 #21 #27 #33 <br /> 4. Vacuum/ Pressure after 3 minutes, inches of water: 2.03 <br /> 5. Vacuum/ Pressure after 4 minutes, inches of water: 2.04 #4 #10 #16 #22 #28 #34 <br /> 6. Vacuum/ Pressure after 5 minutes, inches of water: 2.05 <br /> #5 #11 #17 #23 #29 #35 <br /> 7. Allowable final vacuum: 1.77 <br /> ® PASS ❑ FAIL #6 #12 #18 #24 #30 #36 <br /> I declare, under penalty of perjury under the laws of the state of California that based on information and belief formed after reasonable inquiry, the statement <br /> and information provided in the document are true, accurate, and complete. <br /> Technician Signature: <br />