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AFFO A -T T o <br />416 2na street Galt, 5632 AST ANK TESD ^� C <br />209 744-0112 Fax 209 744-0116 <br />Site:1100 <br />Test Date: <br />Address <br />City: 3 " Equipment "Lard <br />Comments — (include information on repairs made to testing) <br />Technician: Lyle D. Nimmo ICC #5249115 -UT Exp. 07/01/09 <br />Signature: ac Date: i <br />Test Method Developed By: Tank Manufacturer Industry Standard r Professional Engineer <br />Other (Spec): <br />Test Method Uses: ( � Pressure Vacuum Hydrostatic <br />Other (Specify)- <br />Measuring Equipment Used for Testing: <br />4 �✓: . <br />Tank # <br />Tank # <br />Tank # <br />Tank # <br />Tank Capacity: <br />w <br />Tank Material: <br />Product Stored: <br />Wait time between applying <br />Pressure/vacuum/ water and starting <br />test: <br />". <br />Test Start Time: <br />Initial Reading (Ri): <br />Test End Time: <br />Final Reading(Rf): <br />.. . <br />Test Duration: <br />Change in Readin Rf-Ri : <br />?; <br />Pass/Fail Threshold: <br />Test Result: <br />Was sensor removed for testing? <br />Was sensor properly replaced after <br />testing? <br />a <br />Comments — (include information on repairs made to testing) <br />Technician: Lyle D. Nimmo ICC #5249115 -UT Exp. 07/01/09 <br />Signature: ac Date: i <br />