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POB 36 26515 N. SACTO. BL. LINE TEST <br /> AFFORDA-TE$T THORNTON, CA. 95686 REPORT <br /> 209 794-0102 800 524-9087 <br /> FEAT URIN(i PETRO-TITF. <br /> / u LINE TESIER <br /> STATION# C���� TEST DATE 17) <br /> OWNER ',( (( OPERATOR/ /� <br /> NAME V)�® LT I MGR PkA "r, 'A 7� <br /> PHONE ( PHONE <br /> SITE <br /> ADDRESS ADDRESS 'I 70 7 l I Iq v <br /> o <br /> CONTRACTOR/ENGINEER <br /> ORDERING TEST I�P®61 S�D�� �yN7 k- Zw <br /> REASON FOR TEST A)e W pl n'e 'kala uof <br /> LINE(S) ONLY 8 TANK(S), LINE(S) & LEAK DETECTOR(S) <br /> LINE(S) & LEAK DETECTOR(S) TANK & LINE <br /> uaweoxn <br /> LOCATION SKETCH �-. 'o1 p p' y / I <br /> MAKE R TYPE OF PI IMP l 1'i44" '3 prrzAN e T' <br /> OR DISPENSER l I �Zy 1.�I.r p� LIZ,1 V P 0 <br /> a <br /> COVEROVER <br /> LMES IIJI <br /> APEPIN BURIAL 10 h g <br /> WEATHER C1 'bD D F 11 <br /> CONTRACTOR CERTIFICATIONrb <br /> b <br /> OTTL LIC # 91-1143 4" 6L,PETROTITE CERT.#090993AO163 <br /> 1901&3 <br /> TECHNICIAN: LYLE D. NIMMO <br /> za�zs <br /> SIIUW STREETS SLUGS TANKS ISLANDS PIPING IE KNOWN PUMPS OR DISPENSERS <br /> SIGNA' <br /> TEST RESULTS <br /> TF,S7S B'FRF.AIADF.ON 7'NF LINF.SYSTEMS AS NOTE,'D IN ACCORDANCE 11'I7717'EST PROC E'DURES PRESCRIBED FOR <br /> AS UFTAII.F.D ON 771E TEST('IIART ON SII)F 2 OF77IN Ft)RAI 11777IRFSUL7'SAS FOLL0B5: <br /> LINE IDENTIFICATION NET VOL[ CHANGE PER HOUR <br /> V w 0 PASS FAIL / INCONCLUSIVE — .00D <br /> (� ASS / FAIL / INCONCLUSIVE — 0030 <br /> PASS / FAIL / INCONCLUSIVE <br /> PASS / FAIL / INCONCLUSIVE <br />