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416 . Street <br />AFFORDA <br />(209) 744-0112 (209) 744-0116 FAX <br />SITE NAME <br />ADDRESS <br />0 <br />TEST DATE -eril S-,_2 <br />PHONE (ZOCI )yy(o-58th <br />CONTACT:T�Go A <br />Present f1 Not Present <br />3. SPILL BUCKET TESTING INFORMATION <br />Test Method Used: ydrostatic ❑ Vacuum ❑ Other <br />Test Equipment. Used: Tfoo Equipment Resolution: ° fb <br />Identify Spill Bucket (By Tank 1 Z2 <br />Number, Stored Product, etc. <br />-p 3 v t_ <br />4 <br />Direct Bury <br />Bucket Installation Type: ❑ Contained in Sump <br />Direct Bury Direct Bury <br />❑ Contained in Sump ❑ Contained in Sump <br />❑Direct Bury <br />❑ Contained in S ump <br />Bucket Diameter: 1Al <br />Bucket Depth: t <br />1514 , t - <br />Wait time between applying <br />vacuum/water and start of test: <br />Test Start Time (T): / <br />/1-1 <br />Initial Reading (RD: 1®--- <br />I '/2 0 -- <br />Test End Time (TF): ®S <br />Oe5"- <br />t.5 10(5 - <br />Final <br />Final Reading (RF): <br />-.— <br />Test Duration (TF — TI): Q, <br />Change in Reading (RF - Ri): <br />Pass/Fail Threshold or <br />Criteria: <br />- unccuae inTormanon on <br />to testin,e. and <br />Test Water: ❑Taken with tester_. Left 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 />OTTL #: <br />Zane A. Nimmo <br />5263322 -UT <br />