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AFFORDA-TE$I@ <br />4.16 2nd Street Gait CA 956-w <br />(209) 744-0112 (209) 744-0116 <br />LINE & LEAK DETECTOR <br />TEST REPORT <br />CONTRACTOR/ENGINEER TEST DATE —� -- <br />SITE N�IIE �, C�Cx ,2 l!Q �l �� I �'7 PHONE <br />ADDRESS &EDO <br />Compliance <br />Repair/Construction <br />Escrow <br />LOCATION SKETCH Show North <br />SHOW STREETS, aLDGS, TANKS, ISLANDS, PIPING (IF KNOWN), PUMPS OR DISPENSERS <br />Insurance <br />Make & Type of Pump or Di enser <br />,-,, <br />Cover Over Lines <br />Approx Burial Depth <br />Weather <br />rssUre SUCtIOn <br />librated to 3 gph @ 10 psi <br />FTA LEAK DETECTOR TEST INFORMATION Calibrate <br />10 PSI <br />K DETECTOR KEY <br />Disp#I <br />Product <br />LD <br />Key <br />Serial Number <br />Resiliency <br />Opening <br />Time <br />In Seconds <br />Leak <br />Rate <br />ML/Min <br />Functional <br />Element <br />Holding PSI <br />Metering <br />PSI <br />Pass ! Fall <br />LD 2000 <br />P / F <br />LD 2000 E <br />P / F <br />XIV <br />P / F <br />FX�, DV <br />P / F <br />E <br />STPN LD <br />P / F <br />F <br />STPML,,D - D <br />P / F <br />G <br />STPMLL - E <br />P / F <br />H <br />STPMLD - LWE <br />Notes: <br />CONTRACTOR <br />CERTIFICATION <br />Technician: Lyle D. Nii=, o <br />,,- <br />LINE TEST RESULTS <br />Tests were made on the line systems as noted in accordance with test procedures <br />prescribed for as detailed on the test chart on Side 2 of this form with results as follows: <br />LINE IDENTIFICATION, NET <br />VOLUME CHANGE PER HOUR <br />P ITE CERT# <br />0909 3AO163 <br />OTTL Lic# 97-1143 <br />p ' PASS / FAIL / INCONCLUSIVE <br />i PASS / FAIL / INCONCLUSIVE <br />Trainee: <br />PASS / FAIL / INCONCLUSIVE <br />PASS / FAIL / INCONCLUSIVE <br />EQUIPMENT: PETRO TITE LINE TESTER <br />