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7 AFFORDA-TE$T, <br />,•il <br />ADDRESSo <br />�a <br />.- <br />a <br />Inspector: il �--,::� T- a— IP <br />3. SPILL BUCKET TESTING INFORMATION <br />TEST DATE <br />PHONE <br />CONTACT: ' I cf <br />/ Not Present <br />Test Method Used: <br />Hydrostatic <br />0 Vacuum <br />❑ Other <br />Test Equipment Used: <br />4 VL -V <br />quipment Resolution: <br />" <br />En9FTFF!!TM <br />Identify Spill Bucket (By Tank <br />Number, Stored Product, etc) <br />1 <br />MW <br />2 3 <br />4 <br />Bucket Installation Type: <br />_ irect Bury <br />0 Contained in Sump <br />❑ Direct Bury <br />❑ Contained in Sump <br />0 Direct Bury <br />0 Contained in Sump <br />❑ Direct Bury <br />❑ Contained in Sum <br />Bucket Diameter: <br />l <br />Bucket Depth: <br />Wait time between applying <br />vacuum/water and start of test: <br />Test Start Time (TI): <br />f <br />Initial Reading (R[): <br />Test End Time (TF): <br />Final Reading (RF): <br />�r <br />Test Duration (TF — Tl): <br />f <br />Change in Reading (RF - RO:-- <br />Pass/Fail Threshold or <br />Criteria: <br />Uommen ts - (include information o zrs made prior to testing, and recommended follow-up for failed tests) <br />Test Water: ❑Taken with tester ®Lefton site <br />1 hereby certify that all the information contained in this report is true, <br />accurate, and in full compliance with legal requirements. Technician:' <br />f� b <br />ICC#: <br />Signature OTTL #: <br />Lyle D. • <br />,a <br />