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416 2nd Street Galt CA 95632 <br />AFFOR®A-TE$T (209) 744-0112 (209) 744-0116 FAX <br />SITE NAME '�)AnJ JoG?au.trl Ur -I`4 Wo<,u1-1 <br />ADDRESS 6-oO <br />re g KY -14 CA iA7) q � <br />Inspector. <br />3. SPILL BUCKET TESTING INFORMATION <br />Spill Bucket <br />Test Report <br />TEST DATE &A <br />PHONE( 209 <br />CONTACT: <br />Present 1 / Not Present <br />71 <br />Test Method Used: <br />(Hydrostatic <br />❑ Vacuum <br />❑ Other <br />Test Equipment Used: -z- Q <br />Equipment Resolution: <br />1 <br />Identify Spill Bucket (By Tank <br />Number, Stored Product, etc. <br />1 <br />E <br />2 <br />3 <br />4 <br />Bucket Installation Type: <br />❑ Direct Bury <br />Contained in Sump <br />0 Direct Bury <br />0 Contained in Sump <br />❑ Direct Bury <br />0 Contained in Sump <br />❑ Direct Bury <br />❑ Contained in Sump <br />Bucket Diameter: <br />Q <br />Bucket Depth: <br />% t <br />4° <br />N <br />Wait time between applying <br />vacuum/water and start of test: <br />Test Start Time (Ti): <br />Initial Reading (RI): <br />Test End Time (TF): <br />Final Reading (RF): <br />//,z - <br />Test <br />Test Duration (TF - Ti): <br />D va I rJ <br />`. t <br />h <br />i, <br />Change in Reading (RF - Ri): <br />Z- <br />Pass/Fail Threshold or <br />Criteria: <br />_ — <br />mo <br />_Mmmm <br />MINIMUM <br />,Comments—. (include information on Egpe0s made rior to testin and recommended follow-up jjoor failed tests) <br />16) <br />Test Wates Taken with tester EELeft on site <br />I hereby certify that all the information contained in this report is true, <br />accurate, and in full compliance with legal requirements. Technician:. <br />ICC #: <br />Signature ' . _. OTTL #: <br />Zane A. Nimmo <br />5263322 -UT <br />04-1676 <br />