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' 2-06; 12: 00PNi;S a c re.rnen`n EMC <br />;916 9252816 # F11 ii <br />aC'r&r t rt'. ''y;iip-n�nt 1,v`&it:rzuce Company, Inc Work QrLlOr 4 1,22'462 <br />Site Address: 7/11 #19976 Date of Testing/Servicing: 08-16-06 <br />1399 North Main Street <br />:Manteca, Ca. 95336 <br />209-239-3152 <br />I. Results of V acuum!Premure Monitoring Equipment Testing % <br />his p -.W; should be used to document testing and servicing of vacuum and pressure interstitial sensors. A copy of this form rr,94 be included with <br />the Monitoring System Certification Form, which must be provided to the tank system owner/operator. The owner/operator ust submit a copy of <br />the I\Aonitoring System Certification Form to the local agency regulating UST systems within 30 days or test date. <br />P�lanufactu:^-: ( <br />-Model; <br />System Type: <br />❑ Presst e ❑ Vacuum <br />er.so! 'iJ <br />Pass <br />Fail <br />Fps, cal' <br />Componem(s) monitor by this Sensor <br />SenSOT Furct fonah"y Test Results: <br />Interstitial Commu cation Test Result: <br />C empoz en;:(s) rnonitcr by this Sensor <br />so- .n..;;naii'y =est R.;u1ts: <br />Interstiti CommunicationTes.Ecs:': <br />Component(s) monitor by this Sensor <br />{ Sensor Functionality Test Results: <br />terstitial Communication Test Result: <br />J Componeat(s) monitor by this Sensor <br />j `>:nsor `runc.icnadty'Test Results: <br />Component(s) monitor by this Sensor <br />Sensor Fu^ctionality T si Results: <br />Interstitial Cammunication Test Result: <br />—T <br />lntetstitiai Cormnua:cation Test Result: <br />` <br />__. <br />Componen (s) monitor by this Sensor <br />` <br />Sensor Functionality Test Results: <br />Interstitial Communication Test Resu:: <br />Component(s) monitor by this Sens. <br />1 Sensor Functionality Test Results: <br />Interstitial Communication Test Result: <br />b Comp.neut(s) monitor by th' Sensor <br />a <br />S msor Functionality Test exults: <br />Interstitial Communication 'rest Result: <br />Component(s);non r by this Sensor <br />Sensor F.L'ic`ioDa .ty est Results: <br />Interst tial Contmwiication Test Result: <br />Q arr?pore;at j, mor. ito: by th.:s Sensor <br />V <br />Sensor F ctionality .est Results: <br />interstitia: Communication Test Result: <br />How was interstitii) ce nunieation verified: <br />Lcak Introduced Far End of Interstitial Space; (1) <br />d i <br />Gauge; <br />Visual Inspection <br />Other (Describe in section. <br />r`, below) <br />Vacuum was res t°ed to operating leveis in all interstitial spaces: <br />Yes <br />No (if no, describe in <br />section 3, below <br />J. Comments: <br />1' if sh s7rr- s cccssf311y detects a sintt>'ated �acuum/pressure leak introduced in the interstitial space at the furthest point from the. sensor, <br />