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Afforda-Te$t _ Spill Bucket <br /> 416 2nd Street 209 744-0112 Test Report <br /> Galt, Ca. 95632 FAX 209 744-0116 1� <br /> I. FACILITY INFORMATION <br /> FacilityName: 13 ,TT I Date of Testing: <br /> Facility Address: 14 a I <br /> Facility Contact: Vq t y Phone: 2 O" <br /> Date Local Agency Was Notified of Testing: (g;,/,:z 64, f 00 )1 <br /> Name of Local Agency Inspector(if present during testing): i' <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: a t. 01 b w 4, <br /> Technician Conducting Test: C ( F e <br /> Credentials: ❑CSLB Contractor 2100 `Service Tech. PSWIR%Tank Tester ❑Other(Specify) <br /> License Number(s): 6-A-" 1/6--147' -11 K3 <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used: 171•P!x s ct r Ha-D —7-yo r# Equipment Resolution: <br /> Identify Spill Bucket(By Tank 1 2 3 4 <br /> Number,Stored Product, etc.) An i e 5 a l bo Vf,-5 o f <br /> pct Bury C-Direct Bury ❑Direct B ❑Direct <br /> Bucket Installation Type: Bury Bury <br /> ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump ❑Contained in S <br /> Bucket Diameter: /--%, <br /> Bucket Depth: 3 1 <br /> Wait time between applying <br /> vacuum/water and start of test: �- <br /> Test Start Time(Til: s7f 7j`.Jr <br /> Initial Reading(Ril: " <br /> Test End Time(Tp): /-,/0/ <br /> Final Reading(RF): -2 ;� ' <br /> Test Duration(Tp-TO: fa <br /> Change in Reading(Rp-R): <br /> Pass/Fail Threshold or <br /> Criteria <br /> Comments-(include information on re/airs made prior to teestting, and recommended follow up far failed tests) <br /> T�5t ko Ae -T U9 t <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereby certify that all the information contained in this report is true,accurate,and in full compliance with legal requirements. <br /> Technician's Signature: .. �fi �.: Date: l✓ ..."� •. .(,'�� <br />