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RECEIVED <br />SEP 0 3 2915 <br />it <br />dalm <br />to I y1t <br />416 2"d Street Phone: (209) 744-0112 <br />Galt, Ca 95632 Fax: (209) 744-0116 <br />afforda@softeom.net <br />wFai®ru^CDA T4ACAi- <br />LINE & LEAK DETECTOR <br />TEST REPORT <br />CONTRACTOR/ENGINEER BAGLEY <br />SITE NAME:SAN JOAQUIN HOSPITAL TEST DATE 8-27-15 <br />SITE ADDRESS 500 WEST HOSPITAL RD PHONE �) - <br />CITY FRENCH CAMP <br />❑ Repair/Construction <br />LOCATION SKETCH Show North <br />® Compliance ❑ Owners Request <br />SHOW STREETS, BLDGS, TANKS, ISLANDS, PIPING (IF KNOWN), PUMPS OR DISPENSERS <br />Insurance ❑ Escrow <br />Other <br />Make & Type of Pump or Dispenser <br />RED JACKET <br />Cover Over Lines <br />CONCRETE <br />Approx Burial Depth <br />24' <br />Weather <br />SUNNY <br />® I Pressure I Suction ❑ <br />LEAK DETECTOR <br />Calibrate <br />FTA LEAK DETECTOR TEST INFORMATION 10 PSI <br />KEY TYPES <br />No/ <br />Product <br />LD <br />Key <br />Serial <br />Number <br />Resiliency <br />Opening <br />Time In <br />Seconds <br />Test Leak <br />Rate <br />ML/Min. <br />I Element <br />Holding <br />PSI <br />Metering <br />PSI <br />Pass/ <br />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 <br />Notes: <br />CONTRACTOR <br />CERTIFICATION <br />Technician: <br />Felix Ramirez <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 VOLUME CHANGE PER HOUR <br />PETROTITE CERT. #: CCA: 0203032811C <br />OTTL License #: 08-1740 <br />RED DIE ®PASS ❑FAIL ❑INCONCLUSIVE .0000 <br />❑PASS ❑FAIL ❑INCONCLUSIVE <br />Trainee: <br />[--]PASS ❑FAIL ❑INCONCLUSIVE <br />❑PASS ❑FAIL ❑INCONCLUSIVE <br />EQUIPMENT: PETRO TITE LINE TESTER <br />❑PASS ❑FAIL ❑INCONCLUSIVE <br />