Laserfiche WebLink
AFFORDA-TE$T Site Name: Pacific Service Station <br /> 416 2nd Street Address:6131 PACIFIC AVE <br /> Galt, CA 95632 City: STOCKTON CA Zip: 95207 <br /> (209) 744-0112 Fax (209) 744-0116 Facility Permit #: N388 <br /> Date:08-31-17 Time: 900 <br /> Technician: FELIX GAINZA RAMIREZ <br /> District Cert #: 0099 Exp. 2018 <br /> Healy Cert #: 2866213761 Exp. 2018 <br /> Digital Manometer Calibration Date: 06-15-17 <br /> HEALY TEST FORM <br /> Clean Air Separator Pressure Performance Test Nozzle Bag Test <br /> Fuel Grade: 87 <br /> Initial Vacuum/Pressure prior to test ® - ❑ + Nozzle Type: 900 <br /> 1. Initial Vacuum / Pressure (W.C.) 2.0 #1 PASS #7 PASS #13 #19 #25 #31 <br /> 2. Vacuum/Pressure after 1 minute, inches of water: 2.0 #2 PASS #8 PASS #14 #20 #26 #32 <br /> 3. Vacuum/Pressure after 2 minutes, inches of water: 2.0 <br /> 4. Vacuum/ Pressure after 3 minutes, inches of water: 2.0 #3 PASS #9 #15 #21 #27 #33 <br /> 5. Vacuum/ Pressure after 4 minutes,inches of water: 2.0 #4 PASS #10 #16 #22 #28 #34 <br /> 6. Vacuum/Pressure after 5 minutes, inches of water: 2.0 <br /> #5 PASS #11 #17 #23 #29 #35 <br /> 7. Vacuum/ Pressure after 5 minutes,inches of water: 0.7 <br /> ® PASS ❑ FAIL #6 PASS #12 #18 #24 #30 #36 <br /> I declare, under penalty of perjury under the laws of the state of California that based on information and belief formed after reasonable inquiry, the statements <br /> and information provided in the document are true, accurate, and complete. a <br /> 0 O cn <br /> 1711 z <br /> Technician Signature: 71, <br /> —1 Z cry <br /> D N <br /> Z _ -_J <br /> rn <br /> rA- <br />