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4162"d Street <br /> ® Galt, CA 95632 <br /> (209) 744-0113 Fax (209) 744-0116 <br /> E.O.VR-203/204 <br /> Vapor Pressure Sensor Verification Test & VST Processor Activation Pressure <br /> Test Report Form <br /> Test Company: AFFORDA TEST <br /> Permit Number: 416 2ND STREET GALT, CA 95632 <br /> 209-744-0113 FAX 209-744-0113 <br /> Site Name: QWIK SERVE Technician: David Winkler <br /> Site Address: 950 WEST 11TF4 STREET 4kGertz 11� r t pt {tlnxDt ,4 <br /> City: TRACY CA Zip: District: SJVAPCD-N Select Exp. Date <br /> Date/Time of Test 8-17-11 12 VST: DAVID WINKLER # 1360 <br /> Veeder-Root: DAVID WINKLER #B34975 <br /> Pressure sensor located at dispenser number(s) 1-2 <br /> Pressure sensor serial number 9619 <br /> Calibration date for digital manometer(must be within 12 months of the test) 8-1-11 <br /> Ending value for digital manometer drift test(must be 0.01 in. w.c. or less) 0 <br /> f Y . 5 •��+� 4` ,^�-X hyo <br /> SEN'S(j...h tt" <br /> UST pressure from digital manometer(in. w.c.) 1.98 <br /> Pressure sensor value from TLS-350(in. w.c.) 1.95 <br /> Is Pressure Value Between -0.20 and+0.20 in. w.c.? YES <br /> �, R r <br /> 'VAPOR>?1ZESSI 51f� T > �� <br /> ,�, �a ,,..., •°,��7.. <;....., ., ^s. ++).r, •. r �', vim. + y*, �,, w t <br /> - .5. r!,- <br /> Non-calibrated pressure sensor value from TLS-350(in. w.c.) -,008 M <br /> Is pressure value between-0.20 and+0.20 in. w.c.? YES <br /> PR®e.FirSS�R ACT1" 'R�it ' � w € <br /> r <br /> t, <br /> VST processor activation pressure(in. w.c.) NA <br /> Is the VST processor activation pressure<_0.4 in. w.c.? NA <br /> NOTES: 'Valve must be returned to normal operating position after testing is completed. <br /> 'The ambient reference port cap must be in place after testing is completed. <br /> I declare, under penalty of perjury under the laws of the state of California that based on information and belief formed after reasonable inquiry, the statements and <br /> information provided in this document are true,accurate,and complete. <br /> Signature of Technician: Date: 8-17-2011 <br /> Ver. 1.3— 12.13.08 . <br />