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09.'21.`2009 11: 37 12093341" FLAGCITY CHEVRON PAGE 05!05 <br /> Icieciare, underpenaity ofperjury under tyle laws o{the state of Culi(orn_.hat based on information <br /> S l �m fter.reasonable inquiry, the statements..and.information.provided_in_this_docu» <br /> true, accurate. a"n(feomplete. <br /> ,W <br /> 7--st Wthod d Fscd: Q P"Mure D Vacuuzat. C,i�$y�t�rttst�ti <br /> 0 oonhe:rgmcifi!i <br /> Feat E eat Used: Resolina4�t: <br /> ► 1 v <br /> UDC Matmihf; a 1 ^ CPoly, a I'v IV I K <br /> UAC h: Z x 2 pt 2.1'an too � tt 11 <br /> Night ftm rJDC 30=-n to Top �� <I it: rr• !r <br /> of Hiahest ftft PeDetrati-on; g�" <br /> rcigrre Mora iJBC Botcosxs to te'r'ra <br /> Lowest Elecetxikvl Penetratins: " " ,.,,R <br /> 'Condkton of VDC:prior co t r <br /> L -cry <br /> Pry c:IT"C 1�45LY� f i j b i j W rt. "`F".ii a 1, <br /> Dom tuibiroC abet down when .. <br /> t1�C sura*t gsrid!bn& D Yes 0 No F NA.. Q Yas ONO .0 NA .. 01' e;1I 2 ,, 1-t Yrs C T'iro z? <br /> product and water)?' <br /> Tu`bim s 141timn r ,.��� •"'.rA.r •+se.s <br /> Is s tem progmmuied for Wa 0 Yes ❑No INA, 0 Yes ❑Nb INA, 0 Yes 0 No qNA M Yes 0 No Z <br /> PA eMda�ar�?� <br /> Was fmil•safe verifi®d to be D Yes Q No P'NA 0 Yes Q No Z NA Q'Yes 0 No 0 NA D Yee Q No }n <br /> o 'anal? <br /> W*t tinve bet%veean applying <br /> p"►au v/vac uum/water and -M!0 �"�to iih'�• � ��iOW�.��.r!"�!M!*t ��k�et1�� (.- `A <br /> siac:i'n9 test <br /> Test Stare Time: I!� :Ota p pa ^ •t <br /> tDAW n.CB�}: v er , r, <br /> Teat End Time. <br /> Tose apuratx'dn: , oM! �► _J� o 4�Y" 3 ► -m <br /> �^ � �• .� <br /> I' sil Thad or Cti qia: Irr ` '�:• -*,-- �--- ..,.,.,. <br /> Was smor removed£or C Yes ❑No d NA _Cyea D No CNA Oyes 01% O N& Ia Ycr 'b No ❑t <br /> 'W'es Sawr,proms aphiced etd <br /> verified&mctiosw after ?. D Xcya� ©I�n C1ls&_ ,©Yes ❑No 0 NA C Yea U No q NA ©Yes 01% D� <br /> (include Mprmadon on rraade or.tulesrin ,and,raovamesndedI6rfbtAad:ftsW <br /> U rhe entire depth of the LDC is not teeted,specify bow mtmeh was tested- Fthe sawyer to apsr of the question indicstpd v*h R <br /> astride('}is"W'or"NA",the entim MC nmr,be tc%t2dt, (See S CB LG-160) <br />