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POB 36 26515 N. SACTO. BL, �1�E & LEAK DETECTOR <br />.. � THORNTON, CA. 95686. TEST ,REPORT <br />209 794-0102 800 524-9087 � � <br />CONTRACTOR./ENGINEER TEST DATE <br />ORDERING TEST <br />SITE: <br />OPERATOR %✓ l-�' ��y�f �> Station# OWNER <br />SITE ADDRESS }f,`�� `� 1L /- %r� ADDRESS <br />PHONE ( ) — PHONE 1 " <br />.,. _.. ....... .. .....,.. .e. ...� ... .... .........w...,.-..,.. .,_ ... ,....... �,.,.-,. .... ., .........--�. .. ..,.w..,, ... ..w .. .:.,,w...+n. .� .,..,x...w.. .�.. e•,n.,wr,. .n+w+.nvan++:.:. u•.xu a.. d ,,. ,, ... ....,v. <br />REASON FOR TEST LOCATION SKETCH '11wNCMn <br />ENVHL VUv 1 HEALTH <br />PEi�AA!T,i.SERV!P,ES <br />LINEA ONLY <br />I <br />ITANK(s)-LINE(s <br />LWE(s)-LEAK DET. <br />TANK(s}-LINE(s)-LEAK DET. <br />Lli <br />MAKE & TYPE OF P e,� <br />t <br />OR DISPENSER <br />COVER OVER ,{� p d <br />LINES l U3 �t 1 t -P p- - . <br />�J <br />APPROX BLIR1AL i A <br />DEPTH <br />SHOW STREETS• BLDC3S, TANKS ISLANDS: PIPING (IF KNOWNL PUMPS OR DISPENSERS <br />r <br />WEATHER I <br />PRESSURE <br />SUCTION <br />FTA LEAK DETECTOR TEST INFORMATION Calibrate <br />LEAK DETECTOR 10 PSI <br />No. LD Serial <br />Opening Testunctiona <br />Metering Yes / <br />ENumber Resiliency <br />Time Leak Rate <br />Element PSI No <br />y MES. Product <br />In seconds ML/Min <br />Boldin PSI <br />XLD P/N 116036-5BFLD <br />(XL MODE <br />PAW 116039-5 <br />C PLD P/N 116030-5 <br />XLP P/N 116035-5 <br />DLD PIN116017-5 <br />BF'LD P/N 116012-5 <br />OTHER <br />Notes <br />CONTRACTOR. <br />LINE TEST RESULTS <br />CERTIFICATION <br />TESTS ffERE AMDEON77IELME SYMMSASNOMON ACCORDANCEWITHTEST <br />PROCEDURE, SPRESCRIBED FOR AS DETAILED ON THE TEST CHART ON SIDE 2 <br />OF 77-11s MRM N7TNRESULTS ASMLLOHS.• <br />TEcnmclAN: YLE.D. NIMMO <br />s1GNAivRs . <br />LINE IDENTIFICATION NET VOLUME CHANGE PER HOUR <br />PETROWETE CERT. # 090993AO163 <br />1 p p f <br />1011 <br />PASS FAIL / INCONCLUSIVE <br />` Y` <br />(r fTL LIC N 91-1143 <br />ThineaNarna <br />P WSS FAIL / INCONCLUSIVE <br />r <br />Tri�naS;g,cmaI <br />PASS / FAIL / INCONCLUSIVEFEATURING <br />PETR -TITE <br />LINETESTER <br />, ._ _ <br />PASS.. /...FAIL / INCONCLUSIVE <br />ENVHL VUv 1 HEALTH <br />PEi�AA!T,i.SERV!P,ES <br />