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E.O. VR-2011202 <br /> Healy Clean it Separator Static Pressure Performance Test Report Form <br /> Permit Number. Test Company:B.Z.Service Station Maintenance,Inc. <br /> Site Name: a y Technician: " : s <br /> Site Address:u( 177" TM <br /> City Zip: 7 District: <br /> Dateffime of TesC -2-7-0 (0;3 O vv\ Franklin(Healy): ,ty 3 t W 3161 <br /> TOM R lON r <br /> Calibration date for digital manometer(must be within 180 days of the test) elul <br /> Ending value for digital manometer drift test(must be 0.01 In.w.c.or less) 4 v <br /> -� :. <br /> :. "VAC ;TEST <br /> Vacuum at start of test,Inches of water column(in.w.c.) -0 <br /> Vacuum at one minute,In.w.c.: - O <br /> Vacuum at two minutes,in.w.c. <br /> Vacuum at three minutes,in.wit <br /> Vacuum at four minutes,in.W.O. <br /> Final vacuum at five minute,ln.!w.c. <br /> Allowable minimum vacuum,ink w.c.(from shaded area below) <br /> T"ar did <br /> Aitow tal•.�N�61:6vdeuum a forCl�aeAirSeparator ' <br /> Vacuum at start of test,in. 8.0 7.0 8:0 5.0 4.0 3:0 <br /> W.C. ' <br /> Minimum vacuum after five 5.5 4.7 3:8 3.0 2.2 <br /> min.,in.w.c. <br /> P51'C: PRESS RE'""TEST <br /> Nitrogen Introduction flow rate(must be between 2 and 4 CFM) <br /> Pressure at start of test,in.w.c <br /> Pressure at one minute,In.w.cl <br /> Pressure at two minutes,in.w.r. <br /> Pressure at three minutes,In.w.c. <br /> Pressure at four minutes,in.w.c. <br /> Final pressure at five minute,In'.w.c. <br /> Allowable minimum pressure,in.w.c. . <br /> 1 declare, under penally of pe ' der the laws of the state of California that based on information and belief fonned after reasonable <br /> inquiry, the statements and7n ormafi rovided in the document are true, accurate, and complete. <br /> Signature of Technician: Date: <br /> Ver. LO— 12.26.07 <br />