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AFFORDA-TE$T 416 2nd <br /> Street <br /> 2 gait C 01916 32 "pill Bucket <br /> Test Report <br /> TEST DATE <br /> SITE NAME � / n <br /> V � i PHONE_( <br /> ADDRESS 7 Tr,2z(, ,, 7 1 tjJ1 , CONTACT: <br /> J <br /> Inspector: - Present / Not Present <br /> 3. SPILL.BUCKET TESTING INFORMATION <br /> Test Method Used: [Mydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used: <br /> _ Equipment Resolution: <br /> Identify Spill Bucket(By Tank 1 2 ` .3 4 <br /> Number, Stored Product, etc. l / 0C'� L <br /> E Direct Bury ®"Direct Bury D Direct Bury �,Direct Bury <br /> Bucket Installation Type: ❑Contained in Su ❑Contained in S ❑Contained in Su ❑Contained in Sum <br /> Bucket Diameter: <br /> Bucket Depth: <br /> 1-2- / 7— // <br /> Wait time between applying <br /> vacuum/water and start of test: <br /> Test Start Time(TI): „� ' � ' C� y� <br /> Initial Reading(Rj): <br /> Test End Time(TF): <br /> Final Reading(RF): <br /> Test Duration(TF—TI): <br /> Change in Reading(RF-RI): -- <br /> Pass/Fail Threshold or l6 �( -y� /i& <br /> Criteria: / <br /> dk C] ai' I ., 1, v r. > it1Eilti <br /> ,x�� <br /> Comments — (include informatio epairs made prior t , and recommen e o ow-up for failed to <br /> ate( f JJ CA- 5 , <br /> Test Water. FT Taken with tester j _�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” Lyle D. Nimmo <br /> ICC#: 5249115-UT <br /> Signature: c_ , ��_. �!� OTTL#: 97-1143 <br /> v <br />