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POB 36 26515 N. Sacramento Blvd. Dynamic Back Pressure Test <br /> da-Telt Thornton, California 95686 <br /> f r 09 794-0102 (800)524-9087 FAX(209)794-0112 Static Pressure Deca Test <br /> A11® (2 ) (ST30) AST <br /> � UST <br /> Owner/Contractor/Eng: <br /> TEST DATE: D`' <br /> 1 Com lianceTest AIR QUALTTY AGENCY: <br /> �l 1 PT Initial Test A n 1AA <br /> SITE NAMEi <br /> I <br /> Address: Ij j i Z-` Not Present i <br /> �� ��),N„ME: Don-DtXon Present <br /> Ci : t— j SN Certification#OMNI <br /> Phone: ( ) 3) - ' y >__�% (�I X17 Permit or Facility# <br /> Contact: Tecx SIGNATURE! <br /> Confrrmation# <br /> STATIC PRESSURE DECAY TEST DATA <br /> DISPENSER Make: �` NOZZLE Make: (� <br /> PV Valve Make: ll <br /> / ) c l� <br /> #DISPENSERS Model: <br /> # TOTAL NOZZLES <br /> Model:a v Model: OI <br /> BALANCE ASSIST Assist T e: <br /> MANIFOLDED: Yes ;L No "Wc <br /> '1 Tank 3 Tank 4 TOTAL Initial pressure before testin - -� <br /> 'I Tank 15� Y Tank 2 <br /> Product Grade EQUIPMENT <br /> -�— Decay: Blockage: <br /> # Nozzles per Tank Incline Manometer Incline Manometer <br /> Acatal Tank Capacity Ma ehelic Guaee Maenehelic Guaee �c <br /> Gasoline Volume Equipment Calibration Date: 01/22/2004 <br /> Ulla a Ca aci minus Volume % U I," <br /> Phase I System T e 2 t EVl2) Coaxia' Allowable Fill Time @ <br /> Initial Test Pressure (inches water) 210 <br /> 2 SCFM I ) O <br /> PSi a 1 Minute (Inches Water) Time 1: rn r ^ e <br /> PSI (a) 2 Mioutes �� Time 2, <br /> PSI (a) 3 Minutes I Time 3: <br /> PSI Q, 4 Minutes <br /> Final Pressure (a7 5 Minutes (inches Water) Liquid Removal Check, Dynamic Back <br /> Pressure (if due), and Parts & <br /> Allowable Final Pressure (CARB) <br /> Pass I Fail Pass ! Fail Pass / Fail Pass / Fail ( Pass / Fail Repairs Are Listed on Back <br />