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POB 36 26515 N. SACTO & LEAK DETECTOR <br />xadr�xr�e 568�BL. LI# <br />TEST <br />THORNTON, CA. 9' ST REPORT <br />(209) 794-0102 (800) 524-9087 <br />CONTRACTOR/ENGINEER <br />ORDERING TEST <br />DATE (, — -a- —� — t) <br />SITE: <br />OPERATOR Station# -21- <br />OWNER <br />1 <br />SITE ADDRESS 16- k), 7 <br />ADDRESS <br />y <br />PHONE VC <br />PHONE <br />REASON FOR TEST <br />LOCATION SKETCH JjL-jv3jj IN awmwn <br />r <br />LID <br />SHOW STREETS, BLDdS, TANKS, ISLANDS' PIPING OF YNOWK PMPS-OR DISPENSERS <br />UNE(s) ONLY <br />LjTANK(S)-LINE(S) <br />LINE(s)-LEAK DET. <br />TANK(s)-LINE(s)-LEAK DET. <br />, <br />MAKE & TYPE OF PUNU;- <br />OR DISPENSER 4 <br />7wip, "I <br />COVER OVER <br />LINES Co 4 1, e 110 <br />APFROX BURIAL <br />DEPTH —5 (p <br />WEATBER <br />PRESSURE <br />SUCTION <br />LEAK DETECTOR <br />FTA LEAK DETECTOR TEST INFORMATION Calibrate <br />10 PSI <br />E <br />y <br />TYPES: <br />No. <br />LD <br />Serial <br />Number <br />ResiliencyTimefn <br />0 ening <br />Opening <br />g <br />ds <br />In Seconds <br />Test <br />Leak Rate <br />ML/Min <br />unction <br />Element <br />HoldingPSI <br />PSI <br />Yes <br />No <br />Product rM <br />XLD P/N 116036-5 <br />BFLD 1(y MODE <br />039-5 <br />C <br />PLD P/N 116030-5 <br />XLP P/N 116035-5 <br />DLD P/N`116017-5 <br />-2- <br />Y4-5. <br />BFLD P/N 116012 <br />oTpe <br />Notes <br />R <br />CONTRACTOR <br />ATo <br />C <br />N <br />CERTIFICATION <br />C T'O <br />ITEcumciAN. <br />LINE TEST RESULTS <br />TESTS HEREMADE ON 771E LINE SYSTINS AS NOTED RVACCORDANCE UM TEST <br />PROCEDURES PRESCRIBED MR AS DETAILED ON ME TEST CHART ON SIDE 2 <br />OF 7711S FORM W711 RESULTSAS FOLLOWS <br />LYLE.D. NIMMO <br />D - <br />SIGNATURE <br />LINE IDENTIFICATION NET VOLUME CHANGE PER HOUR <br />PETROM7 CERT. 0 OM93AO163 <br />OM LIC N "-1143 <br />TraimNam <br />(PASS[ FAIL / INCONCLUSIVE <br />Dc 'q0 <br />PASS FAIL / INCONCLUSIVE <br />w -110 <br />TninwSiguhn <br />PASS)/ FAIL / INCONCLUSIVE <br />FEATURINd PETRO-Trm <br />LINE TESTER <br />PASS / FAIL / INCONCLUSIVE <br />8 <br />