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AFF®R®A--rE$T 416 2nd Street Gait CA 95632 LINE & LEAK DETECTOR <br /> (209) 744-0112 FAX (209) 744-011 TEST REPORT <br /> CONTRACTORIENNGINEERqq TEST DATE j C <br /> SITE NAME CdA�OLO 7� # Z 5 PHONE <br /> ADDRESS I20 E: PlogQL <br /> Repair/Construction LOCATION SKETCH Show North <br /> Compliance <br /> Insurance <br /> Escrow CI ISI tJ <br /> Make&Type of Pump or Dispenser <br /> t COAICG'�Te <br /> Cover Over Lines Cl <br /> Approx Burial Depth <br /> 91 <br /> Weather <br /> Sir <br /> Pressure Suction TRE DGS,TANKS,ISLANDS,PIPING(IF KNOWN),PUMPS OR DISPENSERS <br /> LEAK DETECTOR FTA LEAK DETECTOR TEST INFORMATION Calibrate <br /> 10 PSI <br /> Opening I Element <br /> LD Serial Time In Test Leak Holding Pass/ <br /> KEY TYPES No/Product Key Number Resiliency Seconds Rate ML/Min PSI Metering PSI Fail <br /> A LD 2000 <br /> B LD 2000 E <br /> C FXI V <br /> D FXI DV <br /> E STPMLD <br /> F STPMLD- D <br /> G STPMLD- E <br /> H STPMLD-D/E Notes: <br /> CONTRACTOR LINE TEST RESULTS <br /> CERTIFICATION Tests were made on the line systems as noted in accordance with test procedures <br /> Technician:Zane A. Nlmmo prescribed for as detailed on the test chart on Side 2 of this form with results as follows: <br /> LINE IDENTIFICATION NET VOLUME CHANGE PER HOUR <br /> PETROTITECERT# 87 cc--rASS / FAIL / INCONCLUSIVE i6CAXi-, <br /> CCA0202112304R <br /> OTTLLic#04-1676 r OL-r RPASS� <br /> FAIL / INCONCLUSIVE <br /> Trainee: GEuX �i/CyE (Es FAIL / INCONCLUSIVE <br /> PASS / FAIL / INCONCLUSIVE <br /> EQUIPMENT:PETRO TITE LINE TESTER <br />