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From: Franzen-Hill Inc. To: 12094683433 Page:8/8 Date: 1/3/2013 4:58:01 PM <br /> Form 12/2004 <br /> SpillBucket-Tesfin Form <br /> FACILITY INFORMATION <br /> Facility Name:ESCALON MINI MART Date of Testing:12-27-12 <br /> Facility Address: 1097 E YOSEMITE AVE ESCALON CA <br /> Facility Contact:BILL Phone: 209 838 1546 <br /> County: SANJUAQUIN <br /> Name of Local Agency inspector(If present during testing): MUNTAPPA;NAIDU <br /> TESTING CONTRACTOR INFORMATION <br /> Company Name: Franzen-11111111 1100 North 3 Stned Tulare,CA 93274 (559)6W2977 <br /> Technician Conducting Test: ADAM TAYLOR <br /> Credentials: x CSLB Licensed Contractor 0 SWRCB Lwtnsed Tank Tester <br /> License Type: A,B,C-61/D40 RAZZ .License Number: 344147 <br /> SPILL BUCKET CONTAINMENT BOXES <br /> Facili!j is Not With Spill/Overfill Containment Boxes C] <br /> S ilUOverfdl Containment Boxes are Present,but were Not Tested D <br /> Test Method Developed By: a Spill Bucket Manufacturer 0 Industry Standard x Professional Enginief <br /> 0 Other(Specify) <br /> Test Method Used: 0 Pressure 0 Vacuum x Hydrostatic <br /> 0 Other(Specify) <br /> Test Equipment Used: VISUAL Equipment Resolution: <br /> & f;}� Y . of, .._t :;,: ..r,:.:Y e•:...... :;�'^ .;::>«i: f ..t r-r,i,+x.� ,yx,:c.sy;�i:ja ';;:?):`t .�. x: ti.i+.. „i ,;i.: <br /> Bucket:87 Backet:91 Bucket: Bucket <br /> Bucket Diameter: 12 12 <br /> Bucket Depth: 16 16 <br /> Wait time between applying <br /> pressure/vacuum/water and 1 1. <br /> starting test: <br /> Test Start Time. 900 900 <br /> Initial Reading(Rr): 16 16 <br /> Test End Time: 1000 1000 <br /> Final Reading(Rp): 16 16 <br /> TestDuration: IHR IHR <br /> Cbange in Reading(RF-n:. 0 0 <br /> Pass/Fail Threshold or PASS PASS <br /> Criteria: <br /> Test.Result: X Pass Q pot .. X Pass ::0 Fad 0 Past: ®Fail. 0 Pass 0 Fail. <br /> TECHNICIAN_ADAM TAYLOR DATE 12-27-12 <br /> SIGNATURE <br /> This fax was sent with GFI FAXmaker fax server. For more information,visit: http://www.gfi.com <br />