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® <br />All urda11"e't <br />Owner/Contractor/Eng: <br />SITE NAME:`' <br />Site Address: <.. , <br />�4 <br />Phone: <br />Operator Name: <br />POB 36 26515 N. Sacramento Blvd. <br />Thornton, California 95686 <br />209 794-0102 800 524-9087 FAX J2092 794-0112 <br />TEST DATE: — <br />Lyle A Mmmo <br />TECH SIGNATURE: <br />OTTL # 97-1143 <br />LEAK DETECTOR <br />TEST REPORT <br />ENVIRONMENTAL HEALTH AGENCY: <br />Present Not Present <br />INSPECTOR NAME: <br />A LD2000 <br />LEAK DETECTOR KEY <br />C FE Petro STP -MLD <br />G Red Jacket FXIV <br />B 99LD2000 <br />D <br />FE Petro STP -MLD -E <br />II Red Jacket FXIVD <br />E <br />I FE Petro STP -MLD -D <br />F <br />I FE Petro STP -MLD -DE <br />J Other <br />FTA LEAK DETECTOR TEST INFORMATION <br />Calibrated to <br />10 psi <br />Dispenser Product LD Key Serial # <br />Number <br />from above <br />Resiliency Opening Test Leak Rate <br />Time <br />in seconds MI r Minute <br />Functional Metering PSI <br />Element <br />Holding PSI <br />Pass/Fail <br />P <br />P/F <br />%6-- <br />P F <br />P/F <br />P/F <br />P/F <br />P/F <br />P/F <br />P/F <br />P/F <br />J <br />