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AFF®R®A-TE$T 1(416 2nd <br />744-0112 (2 9)I744 0116 FAX <br />SITE NAME —7 _ <br />ADDRESS 1399 ►� <br />Inspector: <br />I i4 S <br />I gPTT.Y. RTT9-Wv r 9FFQ9PYXTr 7TTl-""AN , —.— <br />Spill Bucket <br />Test Report <br />TEST DATE ► ��� �� <br />PHONE (e901 ) 2.- — 3Z <br />CONTACT: <br />Present / Nnt Praccn+ <br />Test Method Used: kydrotatic D Vacuum ❑ Other <br />Test Equipment Used: zd Equipment Resolution: 1 <br />Identify Spill Bucket (By Tank <br />Number, Stored Product, etc. <br />1 <br />4 <br />2 <br />C -� <br />3 <br />Bucket Installation Type: <br />Bucket Diameter: <br />❑ Direct Bury <br />Contained in Su <br />� ( <br />❑ Direct Bury <br />Contained in Sum <br />� <br />❑ Direct Bury <br />❑ Contained in Su <br />11 Direct Bury <br />El Contained in Sum <br />Bucket Depth: <br />13 <br />► i <br />Wait time between applying <br />vacuum/water and start of test: <br />Test Start Time (TI): <br />3O <br />g3 <br />Initial Reading (Rj): <br />I I <br />Test End Time (TF): <br />6030-15 <br />xc) <br />Final Reading (RF): <br />_ <br />Test Duration (TF — Ti): <br />2 <br />Change in Reading (RF - Ri): <br />Pass/Fail Threshold or <br />Criteria: <br />M,.„ , <br />771 <br />_.._.� c[IL tucte a loirri ueri un repairs maae prior to testing, land I ecommended follow-up for failed tests) <br />7�/DE of Q'/ �cc c.lc � `r ,4 s � c � �A k/�✓Gt <br />/All 2) .Suivl'P. <br />Test Water: 4Taken with tester F -11 -eft on site <br />I hereby certify that all the information contained in this report is true, <br />accurate, and in full compliarl-Qe-itvy h legal requirements. Technician: <br />;WICC #: <br />Signature: r,OTTL #: <br />Zane A. Nimmo <br />5263322 -UT <br />04-1676 <br />