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Afforda-Te$t Healy Dispenser Vapor <br /> 416 2"d Street Galt, Ca. 95632 Line Integrity <br /> 209 744-0112 Fax 209 744-0116 <br /> Test Date: 08-30-17 Time: 900 <br /> Site: PACIFIC SERVICE STATION <br /> Address: 6131 PACIFIC AVE GDF#N388-1-7 Confirmation 17-24110 <br /> City: STOCKTON CALIFORNIA 95207 <br /> ❑ Startup H Compliance <br /> Technician: Felix Ramirez#0099 2018 <br /> 1 declare,under penaltyofperjury under the laws of the state of California that based on information and beliefformed after reasonable inquiry,the statements and <br /> information provided in the document true,accurate and complete. <br /> Tech Signature: <br /> Healy Cert: 1009853708 1-15-19 <br /> Pump# 1-2 Motor Serial# Pump#3-4 Motor Serial# <br /> Vacuum Pressure Test : Vacuum Pressure Test : <br /> Initial Reading 87 Final Reading 86 Initial Reading 87 Final Reading 87 <br /> Vacuum Dispensing Test Side A YES Vacuum Dispensing Test Side A YES <br /> Vacuum Dispensing Test Side B YES Vacuum Dispensing Test Side B YES <br /> Vacuum Test Both Side A&B YES Vacuum Test Both Side A&B YES <br /> Electric Button Test—All grades turn on low&high Electric Button Test—All grades turn on low& high <br /> speed: ® Yes ❑ No speed: ® Yes ❑ No <br /> Pump#5-6 Motor Serial # Pump#7-8 Motor Serial# <br /> Vacuum Pressure Test : Vacuum Pressure Test : <br /> Initial Reading 88 Final Reading 86 Initial Reading 87 Final Reading 87 <br /> Vacuum Dispensing Test Side A YES Vacuum Dispensing Test Side A YES <br /> Vacuum Dispensing Test Side B YES Vacuum Dispensing Test Side B YES <br /> Vacuum Test Both Side A&B YES Vacuum Test Both Side A&B YES <br /> Electric Button Test—All grades turn on low & high Electric Button Test—All grades turn on low& high <br /> speed: ® Yes ❑ No speed: ® Yes ❑ No <br /> Pump# Motor Serial# Pump# Motor Serial# <br /> Vacuum Pressure Test : Vacuum Pressure Test : <br /> Initial Reading Final Reading Initial Reading Final Reading <br /> Vacuum Dispensing Test Side A Vacuum Dispensing Test Side A <br /> Vacuum Dispensing Test Side B Vacuum Dispensing Test Side B <br /> Vacuum Test Both Side A&B Vacuum Test Both Side A&B <br /> Electric Button Test—All grades turn on low&high Electric Button Test—All grades turn on low&high <br /> speed: ❑ Yes ❑ No speed: ❑ Yes ❑ No <br /> SEP 1 5 2017 <br /> ENVIRONMENTAL HEALTH <br /> Df7PARTPgEENT <br />