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® 416 2nd Street Galt CA 95632 LINE & LEAK DETECTOR <br /> AFFORDATE$T (209) 744-0112 FAX (209) 744-0116 TEST REPORT <br /> CONTRACTOR/ENGINEER TEST DATE <br /> SITE NAME �0� }- a °� i-t�t�®2- 677,7777 <br /> PHONE (,?-OcA ) 77?jZ —Ljjqj <br /> ADDRESS , z �• G.� $" ;`` I{7t A <br /> Y Repair/Construction LOCATION SKETCH Show North <br /> Compliance <br /> Insurance <br /> Escrow <br /> Make&Type of Pump or Dispenser <br /> GI ot(- - <br /> Cover Over Lines <br /> Approx Burial Depth <br /> Weather <br /> L9--pressure Suction SHOW STREETS,BLDGS,TANKS,ISLANDS,PIPING(IF KNOWN), PUMPS OR DISPENSERS <br /> LEAK DETECTOR FTA LEAK DETECTOR TEST INFORMATION Calibrate <br /> 10 PSI <br /> Opening I Element <br /> LD Serial Time In Test Leak Holding Pass/ <br /> KEY TYKES No/Product Key Number Resiliency Seconds Rate ML/Min PSI Metering PSI Fail <br /> A LD 2000 <br /> B LD 2000 E <br /> C FXI V <br /> D FXI DV <br /> E STPMLD <br /> F STPMLD-D <br /> G STPMLD -E <br /> H STPMLD-D/E Notes: <br /> CONTRACTOR LINE TEST RESULTS <br /> CERTIFICATION—) Tests were made on the line systems as noted in accordance with test procedures <br /> Technici n:Zane N prescribed for o as detailed o <br /> n the test chart hart on Side 2 of this form with results as follows. <br /> L IDENTIFICATION NET VOLUME CHANGE PER HOUR <br /> PETRO TE CERT# RUL PAS / FAIL / INCONCLUSIVE � <br /> CCA0202112304R °a` <br /> OTTL Lic#04-1676 uL PAS / FAIL / INCONCLUSIVE <br /> Trainee: `' ,'�' _ PA / FAIL / INCONCLUSIVE ,m ; <br /> PASS / FAIL / INCONCLUSIVE <br /> EQUIP ENT:PETRO TITE LINE TESTER <br />