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ffo rd a-Te t 416 2"`'Street Phone: (209)744-0112 LINE & LEAK DETECTOR <br /> Galt,Ca 95632 Fax: (209)744-0116 TEST REPORT <br /> afforda@softcom.net <br /> CONTRACTOR/ENGINEER ABLE MAINTENANCE <br /> TEST DATE 4/ 15 / 11 <br /> 5 APR 222011 <br /> SITE ADDRESS 2448 W. KETTLEMAN LANE <br /> ENVIRONMENTAL HEALTH <br /> CITY LODI, CA 95240 <br /> ® ®Repair ❑Construction LOCATION SKETCH Show North <br /> Compliance ❑ Owners Request <br /> ❑ Insurance ❑ Escrow <br /> ❑ Other <br /> Make&Type of Pump or Dispenser <br /> Cover Over Lines <br /> CONCRETE/A-C <br /> Approx Burial Depth <br /> 48" <br /> Weather <br /> CLEAR SHOW STREETS,BLDGS,TANKS,ISLANDS,PIPING(IF KNOWN),PUMPS OR DISPENSERS <br /> ® I Pressure Suction <br /> Calibrate <br /> LEAK DETECTOR FTA LEAK DETECTOR TEST INFORMATION 10 PSI <br /> Opening Test Leak I Element <br /> KEY TYPES No/ LD Serial Resiliency Time In Rate Holding Metering Pass/ <br /> Product Key Number Seconds ML/Min. PSI PSI Fail <br /> A LD 2000 <br /> B LD 2000 E <br /> C FXI V <br /> D FXI DV <br /> E STPMLD <br /> F STPMLD — D <br /> G STPMLD — E <br /> H STPMLD—D/E Notes: <br /> CONTRACTOR LINE TEST RESULTS <br /> CERTIFICATION <br /> Technician: Lyle Nimmo Tests were made on the line systems as noted in accordance with test procedures <br /> prescribed for as detailed on the test chart on Side 2 of this form with results as follows: <br /> !/ LINE IDENTIFICATION NET VOLUME CHANGE PER HOUR <br /> PETROTITE CERT.#: CCA: 0201029110 87 ®PASS ❑FAIL ❑INCONCLUSIVE +.0080 <br /> ICC#5249115UT EX.6-30-11 []PASS []FAIL []INCONCLUSIVE <br /> OTTL License#: 90-1143 EX. 12-31-12 <br /> Trainee: []PASS []FAIL ❑INCONCLUSIVE <br /> ❑PASS ❑FAIL ❑INCONCLUSIVE <br /> EQUIPMENT: PETRO TITELIWE TESTER ❑PASS ❑FAIL []INCONCLUSIVE <br />