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AFFORDA-TE$T Site Name: S B GAS & MARKET <br /> 416 2nd Street Address:515 W. 11TH STREET <br /> Galt, CA 95632 City: TRACY CA Zip: 95367 <br /> (209) 744-0112 Fax (209) 744-0116 Facility Permit #: N-2477-2-3 CONF# 18-25625 <br /> Date:7/11/2018 Time: <br /> Technician: ZANE NIMMO <br /> District Cert #: 0083 Exp. <br /> Healy Cert #: 563743702 Exp. 1/8/2019 <br /> Digital Manometer Calibration Date: 4/13/2018 <br /> HEALY TEST FORM <br /> Clean Air Separator Pressure Performance Test Nozzle Bag Test <br /> Fuel Grade: ALL <br /> Nozzle Type: 900 <br /> Initial Vacuum/ Pressure prior to test ® - ❑ + <br /> #1 PASS #7 PASS #13 #19 #25 #31 <br /> 1. Initial Vacuum / Pressure (W.C.) -2.00 <br /> 2.Vacuum/ Pressure after 1 minute, inches of water: -2.00 #2 PASS #8 PASS #14 #20 #26 #32 <br /> 3. Vacuum/ Pressure after 2 minutes, inches of water: -1.99 <br /> #3 PASS #9 #15 #21 #27 #33 <br /> 4. Vacuum/ Pressure after 3 minutes, inches of water: -1.98 <br /> 5. Vacuum/ Pressure after 4 minutes, inches of water: -1.98 #4 PASS #10 #16 #22 #28 #34 <br /> 6. Vacuum/ Pressure after 5 minutes, inches of water: -1.97 <br /> #5 PASS #11 #17 #23 #29 #35 <br /> 7. Vacuum/ Pressure after 5 minutes, inches of water: -0.80 <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 reosonable!i iWiry, the stdfi6l't ents <br /> and information provided in the document are true, accurate, and complete. `'ry` <br /> a? <br /> ,=n Z <br /> Technician Signature: s <br /> M <br /> G O <br />