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A F F 0 R D A--:TT:E$T 416 2nd Street+ Galt CA 9563 LINE & LEAK DETECTOR <br /> (209) 744-0112 FAX.(209) 744-0116 TEST REPORT <br /> CONTRACTOR/ENGINEER. TES�DA E G t <br /> SITE NAME C I F I PHONE ( ) <br /> ADDRESS <br /> Rep r/Constructio LOCATION SKETCH snow North <br /> Compliance <br /> Insurance <br /> Escrow <br /> Make&Type of Pump or Dispenser <br /> 7'9 6 <br /> Cover Over Lines <br /> Approx Burial Depth <br /> Weather <br /> s.tQ <br /> Pressure Suction ]SHOW 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/Produl t Key Number Resiliency Secondb Rate ML/Min PSI Metering PSI Fail <br /> A LD 2000 <br /> B LD 2000 E <br /> C FXI V 4 <br /> s. 4 <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. Nlmmo 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 /> A020211 CERT# PASS FAIL / INCONCLUSIVE <br /> CCA0202112304R <br /> OTTL Lic#04-1676 PA FAIL / INCONCLUSIVE <br /> Trainee: PASS FAIL / INCONCLUSIVE <br /> PASS / FAIL / INCONCLUSIVE <br /> QUIPMENT:PETRO TITE LINE TESTER <br />