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11/12/2010 08:57 FAX 2083683234 GEORGE KISHIDA INC 1?1003 <br />R 416 2nd Street Gait CA 95632 LINE & LEAK DETECTOR <br />F (209) 744-0112 FAX (209) 744-0116 TEST REPORT <br />rnIVTRACTOR/ENGINEER <br />(SITE NAME <br />!ADDRESS E2r5_ <br />a <br />Repair/Construction <br />Compliance <br />Insurance <br />Escrow <br />hake & Type of Pump or bispenser <br />/ -of A . 1A i :I ar--� <br />Cover Over Lines <br />Burial <br />wfjgml�,D <br />TEST GATE <br />ow <br />SUCE1011 SHOW STREM, SLDGS, TANKS, ISLANDS, PIPING (IF KNOWN), PUMPS OR DISPENSERS <br />nawnhrata <br />FTA LEAK DETECTORTEST INFORMATION' to Psl <br />Opening I Elemetrt <br />LD Serial Time In Test Leak Holding Pass I <br />Nolproduct Key Number Resiliency Seconds Rate M1JMin PSI Metering PSI Pail <br />OtTROTITE CERT# <br />CCAM2112204R <br />OTTL Lic#04-1676 _ <br />.• <br />LINE TEST RESULTS <br />Tests were made on the line systems as noted in accordance with ted pmc;edums <br />pres6r7bed for as detailed on the test chart on Side 2 of th15 form with results as follows: <br />LINE VD NTIFICATION NET VOLUME CHANGE <br />-OI!ac.(PASS / o AIL / INCONCLUSIVE . C> oz., <br />PASS / FAIL / INCONCLUSIVE <br />Qu7* s PASS FAIL / INCONCLUSIVE <br />PASS / FAIL / INCONCLUSIVE <br />9000/T000P) XVa W60 0T0Z/ZT/T1 <br />W <br />i <br />MW <br />• <br />�STPMLD r <br />CONTRACTOR <br />CERTIFICATION <br />.1 I _Lr . .tet.._. ; N fit!. <br />OtTROTITE CERT# <br />CCAM2112204R <br />OTTL Lic#04-1676 _ <br />.• <br />LINE TEST RESULTS <br />Tests were made on the line systems as noted in accordance with ted pmc;edums <br />pres6r7bed for as detailed on the test chart on Side 2 of th15 form with results as follows: <br />LINE VD NTIFICATION NET VOLUME CHANGE <br />-OI!ac.(PASS / o AIL / INCONCLUSIVE . C> oz., <br />PASS / FAIL / INCONCLUSIVE <br />Qu7* s PASS FAIL / INCONCLUSIVE <br />PASS / FAIL / INCONCLUSIVE <br />9000/T000P) XVa W60 0T0Z/ZT/T1 <br />