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A ,.,. %p Lvj A-) Ali. on lk_ I W. "Li.LII <br />M <br />VP, ck L.EAA VB I L L'I UM <br />THORNTON, CA. 95686. TEST' PORT' <br />IL9794-0102 J8001524-9087 <br />_ __'' r t.ec-4 V\ "it.. r L TEST DATE <br />Station# <br />?5 �7O <br />PHONE ( ) <br />REASON FOR TEST LOCATION SKETCH <br />N, u t -N S <br />LINE(s) ONLY ANK(s)-LINE(s <br />LINE(s)-LEAK DET. <br />TANK(S)-LINE(s)-LEAK DET. <br />MAKE & TYPE OF PUMP / <br />OR DISPENSER rrLLb.JL� <br />COVER OVER <br />LINES Ca u c -✓2- -t✓c <br />APPROX BURIAL <br />DEPTH <br />TYPES. <br />XLD PIN 16036-5 <br />Ic <br />PLD P/N 116030-5 <br />D <br />XLP P/N 116035-5 <br />E <br />DLD P/NI16017-5 <br />F IBFLD <br />P/N 116012-5 <br />oTHEs <br />r <br />Emu <br />ADDRESS <br />..•......Ay,.0 .«w..s..sray.rt..a� .��,am...w.r ..+�.•bn•l..a �S+aM.MM14f9M'W.mb,�.wvaatr9m•.^M :.....N .'.. i:.�A�.: ai <br />r <br />\ j I SHOW STREETS, BLDOS, TANKS, ISLANDS: PIPING QF KNOWN). PUMPS OR DISPENSERS <br />FTA LEAK DETECTOR TEST INFORMATION Calibrate <br />10 PSI <br />Oppe�nirl Test unc Cana elerirrg Yes l <br />R�ciffency Tune Leak Rate Element PSI No <br />®pm <br />I Notes <br />CONTRACTOR <br />CERTIFICATION <br />Cechnic• . Nimmo <br />?TR ITE CERT# CAA0202112304R <br />OTTL Lic # 04-1676 <br />minee: <br />'QUIPMENT: PETRO TITE LINE TESTER <br />LINE TEST RESULTS <br />TESTS HEREMADEON 771ELINESYSTIMSASNOTED INACCORDANCEWIM TEST <br />PROCEDURES PRESCRIBED FOR AS DETAILED ON THE TEST CHART ON SIDE 2 <br />OF7711S I'ORM;f,777I.RESULTSAS FULLON'S. <br />LINE IDENTIFICATION,, ^ NET VOLUME 0VANGE PER HOUR <br />PASS .I-`/ FAIL / INCONCLUSIVE t Y n <br />PASS ✓ FAIL / INCONCLUSIVE <br />PASS / FAIL / INCONCLUSIVE <br />PASS../...FAIL / INCONCLUSIVE _ <br />