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�ffarba-Trot <br />CONTRACTORIENGINEER _ <br />ORDERING TEST <br />SITE: S 6 h <br />OPERATOR <br />SITE ADDRESS �, ? i3l7 ✓y <br />PHONE <br />P9 <br />`.11 <br />POB 36 26515 N. SACTO. BL. LINE & LEAK DETECTOR <br />THORNTON, CA. 95686. ,,.f..�, dEFWW PORT <br />209 794-0102 800 524-90i+ `ij: - :`l , <br />_ 'EST DATE _ /— 3 D — U ?� <br />Station# <br />0 <br />REASON FOR TIE_ST/ / <br />TIT <br />LOCATION SKETCH ® d vplct "°" <br />, <br />Lill <br />9, TANKS,ISLANDS, PIPINO F KNOWN PUMPS OR DISPENSERS <br />LINE(s) ONLY <br />I tIAW(s)-LM(s) <br />LINRs}-LEAK DET. <br />TANK LNF49y-LEAK DET. <br />MAKE & TYPE OF <br />OR DISPENSER <br />COVEROVER <br />LINES <br />APPROX BURIAL 3d t t <br />DEPTH <br />WEATHER <br />PRESSURE <br />SUCTION <br />ISHOWSTREETS.81. <br />LEAK DETECTOR <br />FTA LEAK DETECTOR TEST INFORMATION Calibrate <br />10 PSI <br />ENumber <br />y <br />TYPES: <br />No. <br />LD <br />Jnr <br />Serial <br />Resiliency <br />Opening <br />Time <br />In Seconds <br />Test <br />beak Rate <br />ML Min <br />functional <br />Element <br />Holdin PSI <br />PSI <br />Yes / <br />No <br />Product <br />XLD P/N 116036-5 <br />d' -e <br />1?W3 <br />! <br />BFLD (XL MODE <br />PIN 116039-5 <br />L <br />PLD P/N 116030-5 <br />XLP P/N 116035-5 <br />DLD P/N116017-5 <br />BFLD P/N 116012-5 <br />OTHER <br />Notes <br />CONTRACTOR <br />CERTIFICATION <br />LINE TEST RESULTS <br />TESTSKEREMADEON771ELINESYSMdSASNOTED INACCORDANCEWITHTEST <br />PROCEDURESPRESCRIBED FOR AS DETAILED ON THE TEST CHART ON SIDE 2 <br />OF77JISMJ?MWITH RESULTSASFOELONT. <br />TECHMCIAN- .LYL �,D 0 <br />SIGNATURE (1[✓��l <br />LINE IDENTIFICATIO NET VOLUME C GE PER HOUR <br />�,( ,{� <br />PASS FAQ, / INCONCLUSIVE <br />�- (q 0 <br />PETRO CERT. # 090993AO163 <br />OCTL LIC 0 91-1143 <br />Trainee Name <br />PASS / FAIL / INCONCLUSIVE <br />, <br />TninwSivuh n <br />PASS / FAIL / INCONCLUSIVE <br />FEATURING PETR -TITE <br />.- LINE TESTER <br />PASS.. /.,FAIL / INCONCLUSIVE <br />