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/0 h <br />AFFORDA-TE$T <br />416 2nd Street Galt CA 95632 <br />(209) 744-0112 FAX (209) 744-0116 <br />LINE & LEAK DETECTOR <br />TEST REPORT <br />CONTRACTOR/ENGINEER <br />MAr- T. LI u TEST DATE �-1a•� 1 <br />A . i w o � <br />SITE NAME S A'Y Y� W R �� PHONE ( ) <br />=I•I i t-" f"111 l'! C9 f I '- <br />ADDRESS (ol 1 L�j i�Prin F4 G k� a' PEW4117SIERACES <br />4-c<oN GA <br />:yE)2q1 <br />k <br />Repair/Construction <br />Compliance <br />Insurance <br />Escrow <br />LOCATION <br />SKETCH Show North\ <br />\ <br />3 <br />? <br />BLDGS, TANKS, ISLANDS, PIPING (IF KNOWN), PUMPS OR DISPENSERS <br />Make & Type of Pump or Dispenser <br />Cover Over Lines <br />Approx Burial Depth <br />SHOW STREETS, <br />Weather / <br />>4 <br />Pressure Suction <br />LEAK DETECTOR <br />FTA LEAK DETECTOR TEST INFORMATION caii10 PSIPSI <br />KEY TYPES <br />No/Product <br />LD <br />Key <br />Serial <br />Number <br />Resiliency <br />Opening <br />Time In <br />Seconds <br />Test Leak <br />Rate ML/Min <br />I Element <br />Holding <br />PSI <br />Metering PSI <br />Pass/ <br />Fail <br />A <br />LD 2000 <br />B <br />LD 2000 E <br />C <br />FXI V <br />D <br />FXI DV <br />E <br />STPMLD <br />F <br />STPMLD-D <br />G <br />STPMLD-E <br />H <br />STPMLD - D/E <br />Notes: <br />CONTRACTOR <br />CERTIFICATION <br />Technic'a a A. Ntmmo <br />LINE TEST RESULTS <br />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# <br />CCA0202112304R <br />OTTL Lic#04-1676 <br />PASS / AIL / INCONCLUSIVE <br />ASS / FAIL / INCONCLUSIVE <br />PASS / FAIL / INCONCLUSIVE <br />PASS / FAIL / INCONCLUSIVE <br />= �o <br />Trainee: /%/� <br />EOU MENT: PETRO TITE LINE TESTER <br />S3 C: F- +i <br />