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Afforda-Te$t Spill Bucket <br /> 416 2nd Street 209 744-0112 Test Report <br /> Galt, Ca. 95632 FAX 209 744-0116 p <br /> 1. FACILITY INFORMATION <br /> Facility Name: Date of Testing: <br /> Facility Address: JAJ31 1E. fwwrj' D 12-al <br /> Facility Contact: va ue Phone: <br /> Date Local Agency Was Notified of Testing : (o �. . Q(o l loo �l.B <br /> Name of Local Agency Inspector(ifpresent during testing): 't I ( ' <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: ',,,, p p �o <br /> Technician Conducting Test: . C7, <br /> Credentials: - ❑CSLB Contractor RICO Service Tech. ¢$WTWB Tank Tester ❑Other(Specify) <br /> License Number(s): T-7� 116--147' Ct`)_) f H3 <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used: rYhPGC K r Ha�� tt/or Equipment Resolution: 11711. <br /> Identify Spill Bucket(By Tank 1 2 3 4 <br /> Number, Stored Product, etc.) / D. 1,e J CDO i7w-,9 1 <br /> l9ct Bury Lit Bury _ ❑Direct Bury ❑Direct Bury <br /> Bucket Installation Type: ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump ❑Contained in S <br /> ump <br /> Bucket Diameter: -;z- /-.2.. <br /> Bucket Depth: -3 1 <br /> Wait time between applying <br /> vacuum/water and start of test: <br /> 15�1- <br /> Test Start Time(TO: 1-1501 <br /> Initial Reading(RO: " �- <br /> Test End Time(Tr): lwl <br /> Final Reading(RP): 7 :r " <br /> Test Duration(TP-Tj): <br /> Change in Reading(RF-Rj): ,�--- - <br /> Pass/Fail Threshold or <br /> Criteria: <br /> Comments-(include information on rep/airs made prior to testing, and recommended follow-u for failed tests) <br /> CERTIFICATION OF TECFMCLAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereby certify that all the informationcontained in this report is true,accurate, and infull compliance with legal requirements. <br /> Technician's Signature: Date:_ <br />