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416 2"d Street SEP 15 2017 <br /> fforda-Te Galt, CA 95632 <br /> (209) 744-0113 Fax (209) 7444I16 <br /> W; :T <br /> E.O. VR-202 <br /> Veeder-Root In-Station Diagnostics Vapor Pressure Sensor Reference Test & <br /> Site Shutdown Test Report Form <br /> Permit Number: N388-1-7 Test Company:AFFORDA TEST <br /> Site Name:Pacific Service Station Technician: FELIX GAINZA RAMIREZ <br /> Site Address:6131 PACIFIC AVE Certification Number Expiration Date <br /> City:STOCKTON CALIFORNIA Zip: 95207 District: 0099 2018 <br /> Date/Time of Test:08-31-17 Veeder-Root: B34976 2018 <br /> VAPOR PRESSURE SENSOR UST PRESSURE TEST <br /> Calibration date for digital manometer(must be within 12 months of the test) YES <br /> Ending value for digital manometer drift test(must be 0.01 in.w.c.or less) 0 <br /> Digital manometer ullage pressure,inches of water column(in. w.c.) 2.00 <br /> TLS console pressure sensor value,inches of water column(in. w.c.) 1.970 <br /> Is pressure value between-0.20 and+0.20 in. w.c.? PASS <br /> VAPOR PRESSURE SENSOR AMBIENT REFERENCE TEST1,2 <br /> Pressure sensor located at dispenser number(s) 5-6 <br /> Pressure sensor number 3582 <br /> Non-calibrated pressure sensor value,inches of water column(in.w.c.) 0.008 <br /> Is pressure value between-0.20 and+0.20 in. w.c.? PASS <br /> SITE SHUTDOWN TESTS <br /> Test Parameter Test Result.(Y/1) <br /> Was power removed from the TLS-350 console'? YES <br /> Was power to the submersible pump(s)removed by the TLS-350? YES <br /> Was power restored to TLS-350 console? YES <br /> COMMENTS (Include Description of Repairs Made) <br /> NOTES: 'Valve must be returned to normal operating position after testing is completed. <br /> 2The ambient reference port cap must be in place after testing is completed. <br /> 3A certified Veeder-Root technician must perform this test. <br /> 1 declare, under penalty of perjury under the laws of the state of California that based on information and belief formed <br /> after reasonable inquiry, the statements and information provided in this document are true, accurate, and complete. <br /> Signature of Technician: Date: <br /> Ver. 1.2-08.05.08 <br />