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®-r 1- 416 2nd Street Galt CA 9563 LINE & LEAK DETECTOR <br /> a (209) 744-0112 FAX (209) 744-01 TEST REPORT <br /> CONTRACTOR/ENGINEER TEST DATE g yQ <br /> SITE NAME �! L 16�6t'a?Ai PHONE ( ) <br /> ADDRESS 500 oS�tTl(�t_ �oE Ab <br /> F c <br /> Repair/Construction LOCATION SKETCH Show North <br /> Compliance <br /> Insurance --_ <br /> Escrow <br /> Make&Type of Pump or Dispenser <br /> J-4c_06-1 <br /> Cover Over Lines <br /> Approx Burial Depth <br /> Weather <br /> Pressure Suction FISHOW STREETS,BLDGS,TANKS, ISLANDS,PIPING(IF KNOWN),PUMPS OR DISPENSERS <br /> LEAK DETECTOR FTA LEAK DETECTOR TEST INFORMATION Calibrate <br /> .Opening I Element 10 PSI <br /> LD Serial Time In Test Leak Holding Pass/ <br /> KEY TYPES 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 /> Technician:Zane A. Nimlmo prescribed for as detailed on the test chart on Side 2 of this form with results as follows: <br /> LINE IDENTIFICATION NET VOLUME CHANGE PER HOUR <br /> PETROTITE CERT# <br /> j:[PASS'l IL / INCONCLUSIVE <br /> CCA0202112304R <br /> OTTL Lic#04-1676 PASS / FAIL / INCONCLUSIVE <br /> Trainee: PASS / FAIL / INCONCLUSIVE <br /> PASS / FAIL / INCONCLUSIVE <br /> EQUIPMENT:PETRO TITE LINE TESTER <br />