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TE$T 416 2nd Street Galt CA 95632 ill Bucket <br /> AFFORDA® (209) 744-0112 (209) 744-0116 FAX <br /> Test Report <br /> TEST DATE 8/Z 08 <br /> SITE NAME SAM �otFQu„f- 6eA10Me- PHONE ( ) <br /> ADDRESS .BBDO W. LloSp(-rAL. CONTACT• <br /> a dU CA 1A P d 9 5-451 <br /> Inspector: 3,gr( J04Qu/w( Present Not Present <br /> 3.. SPELL BUCKET TESTING INFORMATION <br /> Test Method Used: R Hydr static ❑Vacuum ❑Other <br /> Test Equipment Used: Equipment Resolution: " <br /> t <br /> Identify Spill Bucket(By Tank 1 D 23 4 <br /> Number, Stored Product, etc. D/e-5!5'[- <br /> ❑Direct Bury ❑Direct Bury ❑Direct Bury ❑Direct Bury <br /> Bucket Installation Type: aContained in Sump ❑Contained in Sump ❑Contained in Sump ❑Contained in S <br /> ump <br /> Bucket Diameter: <br /> Bucket Depth: <br /> Wait time between applying <br /> vacuum/water and start of test: <br /> Test Start Time(T): <br /> Initial Reading(RI): <br /> Test End Time(TF): <br /> Final Reading(RF): <br /> Test Duration(TF-TI): <br /> Change in Reading(RF-Ri): <br /> Pass/Fail Threshold or <br /> Criteria: <br /> Comments-(include information on repa s ade prior to testing, and recommended follow-up for failed tests) <br /> eePGz�CacNt7 <br /> Test Water: ❑Take n;,,,,jith tester eft on site <br /> hereby certify that all the information contained in this report is true, <br /> accurate, and in full compliance with legal requirements. Technician:., Zane A. Nimmo <br /> ICC#: 5263322-UT <br /> Signature: OTTL#: 04-1676 <br />