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416 2nd <br /> t CA 95632 <br /> AFFOR®A-TE$T (209) 744 01121 (2 9)I744 0116 FAx Spill Bucket <br /> Test Report <br /> TEST DATE 29, d <br /> SITE NAME $ ) �u r' PHONE ( <br /> ADDRESS 243( �. Mgt�l po sq ot, CONTACT: <br /> S�ocl�rcw CA R'SZO <br /> Inspector: Present / Not Present <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: iK Hydrostatic D Vacuum D Other <br /> Test Equipment Used: q pE t C) Equipment Resolution: 1 <br /> t to <br /> Identify Spill Bucket(By Tank 1 2 3 4 <br /> Number, Stored Product, etc.) WE — nJ D 1 rc. - 5 <br /> ❑Direct B ury <br /> Bucket Installation Type: Bury ❑Direct Bury ❑Direct Bury ❑Drect B <br /> ❑Contained in Sump D Contained in Sum D Contained in su D Contained in S <br /> Bucket Diameter: I Z 12 <br /> Bucket Depth: 13 <br /> Wait time between applying , <br /> vacuum/water and start of test: <br /> Test Start Time(Tj): 1 3Lf 6- <br /> v <br /> Initial Reading W: �;- 4 /-Z- <br /> Test <br /> ZTest End Time(TF): t `f I y Lf 5� <br /> Final Reading(RF): 1/ <br /> Test Duration(TF-Ti): Q LAV- <br /> Change in Reading(RF-Rj): <br /> Pass/Fail Threshold or <br /> Criteria: <br /> a <br /> Comments-(include injorrnation on repairs made prior t testing and recommended follow-up for failed tests) n <br /> Test Water: WFaken with tester Left on 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: , Zane A. Nlmmo <br /> ICC#: 5263322-UT <br /> Signature: OTTL#: 04-1676 <br />