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AFFORDA <br />TE$T <br />0 <br />416 2nd Street Galt CA, 95 32 Spill <br />(209) 744-0112 (209) 744-�11 OAX T <br />est Report <br />SITE NAME`'/�f efig <br />ADDRESS L2� Y /-/, AA <br />S �Pc-OL, CA <br />TEST DATE <br />PHONE <br />CONTACT: <br />Inspector: ': A J L10\1Present 1 / Not Pracant <br />Test Water: Taken with tester ft on site <br />I hereby certify that all the information contained in this report is true, <br />accurate, and in fullcompliance with legal requirements. Technician: <br />ICC #: <br />Signature:!2 / OTTL #: <br />Zane A. Nimmo <br />5263322 -UT <br />04-1676 <br />3. SPILL BUCKET TESTING INFORMATION <br />Test Method Used: <br />drostatic <br />❑ Vacuum <br />❑ Other <br />Test Equipment Used: <br />Ur .P— <br />Equipment Resolution: <br />�f <br />Identify Spill Bucket (By Tank <br />Number, Stored Product, etc.) <br />1 <br />2 3 <br />4 <br />Bucket Installation Type: <br />❑ Direct Bury <br />❑ Contained in Sump <br />❑ Direct Bury <br />❑ Contained in Sump <br />❑ Direct Bury <br />❑ Contained in Sump <br />❑ Direct B ury <br />❑ Contained in <br />Bucket Diameter: <br />Bucket Depth: <br />% y <br />1 I <br />Walt time between applying <br />vacuum/water and start of test:�-- <br />- <br />�--- <br />Test Start Time (TO: <br />2!00 <br />Z Q J <br />(2-0 V <br />U J <br />Initial Reading (RO: <br />f <br />Z%Z <br />i3 <br />Test End Time (TF): <br />c) <br />I o <br />Final Reading (RF): <br />Test Duration (TF - Tj): <br />Change in Reading (RF - R): <br />Pass/Fail Threshold or <br />.Comments - (include information o repairs made prior to testing, and recommended follow -un for faile� tertc) <br />Test Water: Taken with tester ft on site <br />I hereby certify that all the information contained in this report is true, <br />accurate, and in fullcompliance with legal requirements. Technician: <br />ICC #: <br />Signature:!2 / OTTL #: <br />Zane A. Nimmo <br />5263322 -UT <br />04-1676 <br />