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f r a- a ill Bucket <br /> 416 2nd Street 209 744-0112 Test Report <br /> Galt, Ca. 95632 FAX 209 744-0116 <br /> 1. FACILITY INFORMATION <br /> Facility Name: ;( Date of Testing: 7 <br /> Facility Address: GAve 9 <br /> FacilityContct: ® 7 <br /> Phone: 2-o/e^ -447c(-- <br /> Date Local Agency Was Notified of Testing: (p z 01P <br /> Name of Local Agency Inspector(ifpresent during testing): <br /> 2. TESTING CONTRACTOR INFORMATION. <br /> Company Name: <br /> Technician Conducting Test: ` ,L a )lv) 0 <br /> Credentials': 0 CSLB Contractor fffiCC Service Tech. WRCB Tank Tester 0 Other(Specify) <br /> License Number(s): // _a7 _11A,� <br /> 3. S UCIKET.TESTING INFORMATION <br /> Test Method Used: drostatic 0 Vacuum 0 Other <br /> Test Equipment Used: ,p-o gg, 'g- 0 ce Equipment Resolution:®✓ '`f <br /> Identify Spill Bucket(By Tank 1 2 3 4 <br /> Number,Stored Product, eE ®J <br /> Bucket Installation Type: irect Bury190-Direct Bury AibDirect Bury Direct Bury <br /> 0 Contained in Sump 0 Contained in Sump ❑Contained in Sump 0 Contained in Sump <br /> Bucket Diameter: Z." �� ,, /2 ,,; <br /> Bucket Depth: <br /> Wait time between applying <br /> vacuum/water and start of test: <br /> Test Start Time(TO: <br /> Initial Reading(R) <br /> Test End Time(TF): i9Y Ally- <br /> Final <br /> l y-Final Reading(RF): TOP 1-1 <br /> TO r <br /> Test Duration(TF-TO: I �r 1 I �- <br /> Change in Reading(RF-Ri): —70 <br /> Pass/Fail Threshold or <br /> Criteria: <br /> Comments.-(include information on repairs made prior to testing,and recommended follow-up for faile tests) <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereby certify.that all the information.contained in,this report is true,accurate,and in full compliance with legal requirement <br /> Technician's Signature: Date: <br /> —d <br />