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•r Street <br />r •.. i <br />-0112 <br />Gait CA 955632 <br />sTEST <br />INE & LEAK DETECTOR <br />REPORT R <br />CONTRACTOR/ENGINEER <br />TEST DATE dZ /02 <br />SITE NAME <br />PHONE( ) <br />ADDRESS 8Z <br />- C) (J <br />� � <br />Compliance <br />p <br />Repair/Construction <br />Insurance <br />LOCATION SKETCH s ` show �Ilort <br />j' : i <br />FEB 17 2009 <br />Escrow <br />SAN JOAQ0.N COUNTY <br />Make & Type of Pump or Dispenser <br />` <br />ENViROMMENTAL <br />HEALTH DEPARTMENT <br />C <br />Cover Over Lines <br />Approx Burial Depth <br />Weather <br />t <br />SHOW STREETS, BLDGS, TANKS, ISLANDS, PIPING (IF KNOWN), PUMPS OR DISPENSERS <br />PresSUre Suction <br />Calibrated to 3 gph @ 10 psi <br />FTA LEAK DETECTOR TEST INFORMATION <br />Calibrate <br />10 PSI <br />LEAK DETECTOR KEY <br />Disp # / <br />LD Opening Leak Functional <br />Product <br />Time Rete Element Metering <br />Key Serial Number Resiliency In Seconds MUMin Holding PSI PSI <br />Pass / Fail <br />A <br />LD 2000 <br />P / F <br />B <br />LD 2000 E <br />P / F <br />C <br />FXI V <br />P / F <br />D <br />FXI DV <br />E <br />STPMLD <br />P / F <br />F <br />STPMLD - D <br />P / F <br />G <br />STPMLD - E <br />P / F <br />H <br />STPMLD - D/E <br />Notes: <br />CONTRACTOR <br />LINE TEST RESULTS <br />CERTIFICATION <br />Tests were made on the line systems as noted in accordance with test procedures <br />technician: L y18 <br />prescribed for as detailed on the test chart on Side 2 of this form with results as follows: <br />LINE IDENTIFICATION NET <br />VOLUME CHANGE PER HOUR <br />:)E—0T—ITE CERT# <br />)90993A0163 <br />_ <br />PASS / FAIL / INCONCLUSIVE <br />— <br />PASS / FAIL / INCONCLUSIVE <br />)TTL Lic# 97-1143 <br />trainee: <br />PASS / FAIL / INCONCLUSIVE <br />PASS / FAIL / INCONCLUSIVE <br />QUIPMENT: PETRO TITE LINE TESTER <br />