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TP -201.61C or EVR Liquid Removal Test <br />Li uid Kemoval Rate Report Form <br />Permit Number: N30-1-7 #17-23630 Test Company: AFFORDA TEST <br />Site Name: Shop N Go Technician: DAVE WINKLER <br />Site Address: 4511 PACIFIC AVE Certification Number: 0082 <br />City: Stockton ca Zip: 95207 District: SJV <br />Date/Time of Test: 5-8-17 VST (if applicable): 1360 <br />1 <br />HEALTHY LIVING` <br />KS f <br />Expiration Date: 2018 <br />-aux iavit, Yt lvxa 1IsifN <br />Phase II vapor recovery system executive order: ❑ G-70-52 (Pre II <br />-Phase EVR balance for AST & UST) ❑ VR ase balance) <br />203/204 (VST PhH EVR <br />EVR Short VI G I Dispensing <br />Nozzle Fuel Version VF Wi Wr VW <br />VI _ V W —VF <br />Rate <br />Number Grade Volume of Time to Gas drained Gas introduced <br />Gas dtaincxl Gas added to hose Gallons G x 60 <br />G <br />Pass / Fail <br />Gas <br />from hose (ml) (150— 175 ml) dispensed dispense T after afterdispensing Wi - Wr <br />Liquid removal <br />ml)recovered <br />1 87 0 sec.) dispensing (15,_i":) <br />rate (mUgal) <br />2 87 0 <br />PASS <br />3 87 0 <br />PASS <br />4 87 0 <br />PASS <br />5 87 0 <br />PASS <br />6 87 0 <br />PASS <br />PASS <br />1 declare, under penalty of perjury under the laws ofthe state mrcalrfnmm rhnt t, moa <br />mJormanon provtaea in this document are true, accurate, and complete. <br />Signature of Technician: <br />_J..., ,�..w�ru.rurc oryuuy, westatemenrsana <br />** NOTE: For EVR systems — Prior to the Leak Decay Test, if the liquid drained from the hose is <25 ml, record the amount in the EVR short version column, mark the <br />test as pass, and no further testing is required. <br />