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San Joaquin Valley <br />AIR POLLUTION CONTROL DISTRICT <br />E.O.1 <br />Healy Dispenser Vapor Line Integrity Test Report Form <br />Permit Number: <br />Test Company: 8Z SERVICE STATION MAINT <br />Site Name: ECONO GAS <br />Technician: ED STEARNS <br />Site Address: 880 VICTOR ROAD <br />Certification Number Expiration Date <br />City: LODI Zip: <br />District: <br />Date/Time of Test: 8-10-09 130PM <br />Franklin (Healy): <br />DISPENSER VAPOR LINE <br />INTEGRITY TEST <br />Dispenser # <br />Initial Vacuum Amer <br />Closing the Ball Valve <br />H2O) <br />Final Vacuum After SO <br />seconds (in. Heb) <br />Pass/Fail <br />(vacuum reading cannot fall <br />more than 4 in. H2O) <br />1-2 <br />8.1 <br />8.1 <br />P <br />3-4 <br />7.9 <br />7.9 <br />P <br />5-6 <br />8.2 <br />8.2 <br />P <br />7-8 <br />7.9 <br />7.9 <br />P <br />1 declare, under penalty of perjury under the laws of the state of California that based on information and beilef formed <br />after reasonable inquiry, the statements and to armation provided In this document are true, accurate, and complete. <br />Signature of Technician: Date: 9-10-01 <br />Z0012] XQI VIS SDIA2ISS ZS 08EZ TLC 9T6 XVd ZT � 0T—Z/80/T0 <br />