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AFF®R®A®��� 416 2nd Street Galt CA 95632 <br />(209) 744-0112 (209) 744-0116 FA: <br />SITE NAME <br />ADDRESS <br />r <br />t_ OI11Z[ 4 <br />3_ CPIT,T. RTTCWF.T TFCTTIVI--TnrVnnn,r A ��, T <br />Spill Bucket <br />Test Report <br />TEST DATE <br />Test Method Used: ydrostatic D Vacuum ' D Other <br />Test Equipment Used: 0 �'p� 11, I <br />I Equipment Resolution: <br />Identify Spill Bucket (By Tank <br />Number, Stored Product etc. <br />1 2 <br />I/( <br />3 <br />J -743 <br />4 <br />Bucket Installation Type: <br />Direct Bury XDirectBury <br />Contained in S ❑ Contained in S <br />irect Bury <br />Contained in S <br />❑ Direct Bury <br />❑Contained in S <br />Bucket Diameter: <br />Z <br />Bucket Depth: <br />/� y <br />Wait time between applying <br />vacuum/water and start of test: <br />_ <br />Test Start Time (Ti): <br />Initial Reading (R): <br />Test End Time (TP): <br />-7 <br />Final Reading (R,,): <br />Test Duration (TF — Tr): <br />f r <br />Change in Reading (Rp - Rr); <br />Pass/Fail Threshold or <br />Criteria: <br />�� n• <br />111,11111111, 111W I <br />WON <br />§ L1 YR• <br />R <br />� V IIAXacuu —. (encauae Information -un repairs made prior to T»g and recommen eo ow -up for failed tests) <br />Test Water: ®Taken with tester Lefton 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: ' Lyle D. Nlmnno <br />ICC #: 5249115 -UT <br />Signature:; ��? c Lit aG/ OTTL #: 97-1143 <br />