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POB 36 26515 N. SACTO. BL <br />THORNTON, CA. 95686 <br />209 794-0102 800 524-9087 <br />CONTRACTOR/ENGINEER 1rJY�t--t o_ - (ZI L44- t,)A.UT 110 <br />ORDERING TEST <br />' & LEAK DETECTOR <br />TEST REPORT <br />DATE > - -� :2 `7 9 <br />SITE: \�'v\oCL.-� `7(.a <br />OPERATOR StR6910 <br />OWNER <br />SITEADDRESSqf�Q�013, f '^ `j <br />ADDRESS <br />LINE(s) ONLY <br />FANK(s)-LINE(s)- <br />PHONE ( - <br />PHONE - <br />REASON FOR TEST <br />UAQb12kf-- C <br />LOCATION SKETCH NO1^ <br />_ A <br />94 ilj <br />I JJ l <br />Slows IREESS BLDUS TANKS ISLANDS: PIPING OFKNOWN PUMPS OR DISPENSERS <br />LINE(s) ONLY <br />FANK(s)-LINE(s)- <br />134NsrLEAK DET. <br />TANK(s)-LR4E(9)-LEAK DET. <br />MAKE A TTPE OF PUMP <br />ORDIISPENSER Q.J, wAYN <br />COVEROVER <br />LINES (!O�&2 TFL <br />APPROX BURIAL <br />DPNH <br />WP.ATWR S U h n <br />PRESSURE <br />SUCTION <br />LEAKDETECTOR <br />FTA LEAK DETECTOR TEST INFORMATION Calibrate <br />10 PSI <br />E <br />Y <br />nrES: <br />No. <br />LD <br />K" <br />Serial <br />Number <br />Resiliency <br />Oppening <br />Tlme <br />In Seconds <br />Test <br />Leak Rate <br />mLmin <br />Functional <br />Element <br />HoldingPSI <br />PSI <br />Yes / <br />No <br />Product <br />XLD P/N 116036-5 <br />— <br />J3FLD1ML,M DE <br />PIN <br />PLD P/N 116030-5 <br />XLP P/N 116035-5 <br />DLD P/N116017-5 <br />BFLD P/N 116012-5 <br />OTH" <br />Notes <br />CONTRACTOR <br />CERTIFICATION <br />LINE TEST RESULTS <br />TEM HERE AMDE ON 771EMNE SYS7MSAS NOTED INACCORDANCE WMI TEST <br />PROCEDURFSPRESCRIBED FOR AS DETAILED ON WE TEST CHART ON SLUE 2 <br />OF7N1SFt7RM{VM1RESULTSASF U00: <br />TEclwtclAN: LY E D. MUM <br />SAT <br />LINE IDENTIFICATION NET VOLUME 0UNGE PER HOUR <br />Flu E CERT. N 090993A01 <br />OCTL LIC N "-`1�143 <br />mw/� A , T�.J/vb m o <br />...N.m. ZA <br />J PASS / FAIL / INCONCLUSIVE <br />a p v <br />FAIL / INCONCLUSIVE <br />PASS FAIL / INCONCLUSIVE <br />pQ(� <br />"'i'°'7Ad4 <br />0036 <br />FEA MO PEI TITE <br />PASS / FAIL / INCONCLUSIVE <br />