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AFORDA- T e T <br />416 2nd Street <br />Galt CA 95632 <br />Spill <br />LI"C'ket <br />1 u <br />1 <br />(209) 744-0112 <br />(209) 744-0116 FAX <br />4 <br />L <br />c..� - <br />Test <br />Report <br />NAME <br />ADDRESS �y a <br />Inspector: <br />FIVE.. <br />f C,4 c <br />3. SPILL BUCKET TESTING INFORMATION <br />J <br />PHONE <br />CONTACT: j -1c, { v� <br />Present ,' / Not Present <br />Test Method Used: Hydrostatic ❑ Vacuum ❑ Other <br />Test Equipment Used: T PT E <br />Equipment Resolution:' <br />y. <br />Identify Spill Bucket (By Tank <br />Number, Stored Product, etc. <br />1 u <br />1 <br />2 r��- , <br />r i? <br />3 !;'lr <br />V �� �.,'y, f', <br />4 <br />L <br />c..� - <br />Bucket Installation Type: <br />❑ Direct Bury <br />Contained in Sump <br />❑ Direct Bury <br />Contained in Sump <br />❑ Direct Bury <br />OContained in Sump <br />❑ Direct Bury <br />A Contained in Sum <br />Bucket Diameter: <br />1 1 <br />11 <br />I l <br />1 <br />Bucket Depth:` <br />�j i4 <br />✓ Z <br />5 Vq <br />Wait time between applying <br />vacuum/water and start of test: <br />Test Start Time (Ti): <br />0 <br />1 3 v <br />I d c> <br />Initial Reading (RI): <br />12— <br />13 <br />13 - <br />3 -Test <br />Test End Time (TF): <br />i d o <br />i l 3 v <br />i 3 C <br />(1 15 cz> <br />Final Reading (RF): <br />Test Duration (TF — TI): <br />oI e <br />Change in Reading (RF - RI): <br />= - <br />-�---- <br />Pass/Fail Threshold or <br />Criteria: <br />1 �'�. � R, .�i f�Q��a � ., <br />< ?���,r. A�ass . Q a►>ti" <br />COmmentS — (include information on repairs made prior to testing, and recommended follow-up for failed tests) <br />Test Water: ]TakE,-r with tester F� Left on site <br />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 />