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I 1 0 <br />IL EQUIPMENT SERVICE <br />Division of Keitit A. Tallia, Inc. <br />Customer <br />Norms 76 <br />Location <br />633 E. Victor Rd., Lodi, CA 95240 <br />Technician <br />James P. Hesketh <br />11 <br />STATE 1.1('F:NSE No. 323417 <br />CLASSIFICATION: A-1167.., C61D40 <br />STATE ENVIRONMENTAL ASSESSOR No. 01781 <br />Product <br />Reg. <br />Telephone: (209) 754-1808 <br />Fax: (209) 754-5726 <br />Post Office Box 950 <br />750 Industrial Way <br />SAN ANDREAS, CALIFORNIA 95249 <br />Submersible Pump Identification <br />Manufacturer Model No. Serial Number <br />Tokheim 858-34 585 22866 <br />Leak Detector Identification <br />Manufacturer Description <br />Red Jacket Diaphragm -type X <br />Tl -6-048 Piston -type <br />Tamper -proof seal installed? Yes No <br />Leak Detector in Submersible Pump <br />Test at Dispenser - <br />1. Operating Pump Pressure 2 7 psi (para. 15) <br />2. Gallons per hour rate 3 (para. 22) <br />3. Line pressure with pump shut off 27 psi (para. 23) <br />4. Bleedback Test with pump off 15 0 ml (para. 26) <br />5. Step -through time to full flow 2 seconds (para. 30) <br />Date <br />6/8/01 <br />Cather Stvle t_cak Dctccto�r <br />6. Leak detector stays in leak search position. (para. 42) Yes X <br />No <br />LEAK DETECTOR TEST *Complete thermal expansion test <br />Note: Pass Leak detector fits test protocol before failing leak detector. <br />Fail = Leak detector fails test protocol <br />Pass X <br />i <br />=8/01 <br />chnician Date <br />ames P. Hesketh <br />