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• " rr IIII II�� Champion P.O. Box 13059 Sacramento CA 95813-3059 Precision Tank Testing CA 800-660-9443 License No. 73848 NV 800-949-9443 1-916-927-1557 USTest 2NO/P Fax: (916)927-7345 TEST EVALUATION REPORT THE L'S Test 2000 SN ,,,declares a tank to be leakingatfien the measured leak rale exceeds the threshold of.05 gnb and has a probability of false alarm of 1%and a probability of detection oD 9904 Champion assumes no responsibility for product leakage.Our responsibility exlands only to the testing of tanks as to riO or not tisK as of the date and levels tested. Date: '1- . 01j Site ID: (Y)n L 4�fa Operator. Site Address: F i E -L u is City: State: A On Job Site Time: 0-K)o Zip: Phone:'DLm-333- SQOff lob Site Time: ILA00 TEST TEST TEST TEST LEVEL RESULTS ULLAGE RESULTS 1. '019 d/o Oa Q Qf4 1 Pass 0 Fail ❑ 1. 1 °/o SN: t�L`1 Pass j$Fail ❑ 2 O/ OQ ,fi,tyt '- Pass )4 Fail ❑ 2. 1 rte'/a SKI' ;CA PassFail ❑ 3. Q u% Pass $ Fail ❑ 3. SN 1 - DO Pass AFail ❑ 4. Pass ❑ Fail ❑ 4. Pass ❑ Fail ❑ S. Pass ❑ Fail ❑ 5. Pass ❑ Fail ❑ 6. Pass ❑ Fail ❑ 6. Pass ❑ Fail ❑ LINE TEST RESULTS LINE LEAK DETECTOR 1_ t, C6 Ux'16 :: QS Pass VFail ❑ 1. Dur Pass Fail ❑ 2. 00 5 Pass '0 Fail ❑ 2. U-b Pass *(Fail ❑ 3. -Cakx;2 'Y)k Pass V Fail ❑ 3. Cit Pass V Fail ❑ 4. Pass ❑ Fail ❑ 4. Pass ❑ Fail ❑ 5• Pass ❑ Fail ❑ 5. Pass ❑ Fail ❑ 6. Pass ❑ Fail ❑ 6. Pass ❑ Fail ❑ COMMENTS:\) N t11N1 La tt,r�V TANK INFORMATION Minimum Test Time From Differential Volume Chart TANK#! 1. 2. 3. �. 5. 6. DIAMETER Q // /t Ak Tank L &0 wtlu VOLUME 10 k IQ{s_ i. Tank 2: I PRODUCT .U h1, $-.(! +.UY1L Tank 3: In 0 W I K TANK TYPE e s; _ Z Tank 4: PROD LEVEL ] 4 -jr3Tank 5: DIFF/VOLIO�,�il j � jr�7� Tank 6: WATER IN TANK $ WELL POINT AUA- -N-/A ht I A GRNDWATER II II (r Any additional information requested by your office is on file at Champion Precision Tank Testing. TECHNICIAN:William Campbell - LIC. 90-1324-SIGNATUREK�nDATE: 4 A.