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POB 36 26515 N. SACTO. BL. <br />Of% <br />THORNTON, CA. 95686. <br />(2091794-0102 (800) 524-9087 <br />CONTRACTOR/ENGINEER <br />ORDERING TEST <br />SITE: <br />OPERATOR+vf-M Station# <br />SITE ADDRESS <br />E _ns chql 0 K) I b'l" <br />PHONE <br />REASON FOR TEST LOCATION SKEI <br />A- ovviJ Co�p � <br />I.114Rs) ONLY [.LAn(s)-UNE(s) <br />LR4E(s)-LEAK DET. <br />lAfNE & LEAK DETECTOR <br />TEST REPORT �ZV <br />TEST DATE <br />J" <br />aEa <br />rl= <br />MY -4 <br />ORIN <br />DLD P/NlIM�r, <br />1, <br />0 M wwM'ffi=ffM <br />GIN <br />CONTRACTOR. <br />CERTMCATIOV <br />PETROWITE CERT. # 090993AO163 <br />0 fTL LIC N 91-1143 <br />TrKir- N-6 <br />Tmbm Sigmwm <br />FEATURING-PETRO.TrrE <br />% LINE TEST RESULTS <br />TESTS BMEMADE ON WELIAWSYS7MSASN07EDBVACCORDANCEUM TEST <br />— <br />OF 7711S FORM RMI RESUTSAS FULLDNS. <br />TANK(s)-1,114E(s)-LEAK DET. <br />n <br />/fASS\/ FAIL / INCONCLUSIVE <br />� FAIL / INCONCLUSIVE <br />I-PASS <br />PAS A t1 FAIL / INCONCLUSIVE <br />MAKE & TYPE OF <br />Towk k F_ i tn _Z_ <br />PASS.. /...FAIL, / INCONCLUSIVE <br />ORDISPENSER, <br />S 14 1p <br />Q, <br />COVER OVEt4*CpL fit <br />LDW <br />P <br />APPROX BURIAL. <br />DEPTH <br />WEATHER <br />PRESSURE ON SHOW =Ei� <br />I �PJNf <br />� <br />a <br />LEAKDETECTOR FTA LEAK DETECTOR TEST INFORMATION <br />Calibrate <br />10 PSI <br />No. LD Serial <br />emning <br />Test Fundiana <br />cdonalWdering] <br />Yes <br />E Number <br />hXLD <br />I Resiliency ?"ane <br />Leak Rate Element <br />No <br />gK'l <br />Y P;rodquc <br />In Seconds <br />&LWW Hohn PSI <br />PIN 116036-5 <br />� 115 <br />DLD P/NlIM�r, <br />1, <br />0 M wwM'ffi=ffM <br />GIN <br />CONTRACTOR. <br />CERTMCATIOV <br />PETROWITE CERT. # 090993AO163 <br />0 fTL LIC N 91-1143 <br />TrKir- N-6 <br />Tmbm Sigmwm <br />FEATURING-PETRO.TrrE <br />% LINE TEST RESULTS <br />TESTS BMEMADE ON WELIAWSYS7MSASN07EDBVACCORDANCEUM TEST <br />PROCEDURES PRESCRIBED pvR As DETAAM ON THE 7FST CHART ON SIDE 2 <br />OF 7711S FORM RMI RESUTSAS FULLDNS. <br />LINE IDENTIFICATION NET VOLUME C <br />GE PER HO I <br />/fASS\/ FAIL / INCONCLUSIVE <br />� FAIL / INCONCLUSIVE <br />I-PASS <br />PAS A t1 FAIL / INCONCLUSIVE <br />PASS.. /...FAIL, / INCONCLUSIVE <br />