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AFF®RDA -TE T 416 2nd Street Galt CA 95632 <br />(209) 744-0112 (209) 744-0116 FAX <br />SITE NAME <br />ADDRESS <br />is <br />A e_T <br />„f <br />- SPIT,T.RTTC'KF.TTV.4. TYNrUVUnVlt4AmrnXT <br />Spill Bucket <br />Test Report <br />TEST DATEr� o <br />PHONE( 1 <br />CONTACT: Sit A :�•_ <br />Present ) / Not Present <br />Test Method Used: "ydrostatic ❑ Vacuum ❑ Other <br />Test Equipment Used: --(—Apc 4 -L -c) Equipment Resolution: 1 <br />Identify Spill Bucket (By Tank <br />Number, Stored Product, etc. <br />1 8 <br />2 3 <br />- <br />4 <br />Bucket Installation Type: <br />Direct Bury <br />❑ Contained in Sump <br />ULDirect Bury ❑ Direct Bury <br />❑ Contained in Sump ❑ Contained in Sump <br />❑Direct Bury <br />❑ Contained in Sum <br />Bucket Diameter: <br />l 1 <br />l I <br />Bucket Depth: <br />t15 <br />t s <br />Wait time between applying <br />vacuum/water and start of test: <br />Test Start Time (Ti): <br />91zo <br />Initial Reading (RI): <br />9 1� <br />9 '% <br />Test End Time (TF): <br />Ozo <br />a� <br />Final Reading (RF): <br />Test Duration (TF — TI): <br />Change in Reading (RF - RI):-�— <br />Pass/Fail Threshold or <br />Criteria: <br />r , . n � <br />l t' <br />ro e - 1V, <br />OR nI 1 04 AN <br />t—uuuiiCuii — (tnctuae tnjormation on repairs made prior to testing, and recommended follow-up for failed tests) <br />Test�Water: Taken 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: , <br />ICC #: <br />Signature: OTTL #: <br />Zane A. Nimmo <br />5263322 -UT <br />04-1676 <br />