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/e u <br />�t <br />416 2nd <br />Gait CA <br />32 Spill Bucket <br />AFFOR DA-TE$T 209 744-0112 Street (2 09) 744-0116 FAX Test Report <br />TEST DATE - <br />SITE NAME -LiC.1000 PHONE (a o ) 1� <br />ADDRESS i r ��, � �� � '� CONTACT: F6 rc, <br />Inspector: I" i ` CVX 11 C, HiE Uk Cresent / Not Present <br />3. <br />SPILL BUCKET TESTING INFORMATION <br />Test Method Used: <br />Hydrost tic <br />D Vacuum <br />D Other <br />Test Equipment. Used: Tom- <br />fA 2 <br />Equipment Resolution: <br />' / o b <br />Identify Spill Bucket (By Tank 1 <br />Number, Stored Product, etc. <br />j z L— <br />�'1 2 g �";) <br />`� <br />3 <br />4 <br />Bucket Installation Type: Direct Bury <br />D Contained in Sump <br />Direct Bury <br />D Contained in SUMP <br />irect Bury <br />D Contained in Sump <br />❑Direct Bury <br />D Contained in Sump <br />Bucket Diameter: <br />13 <br />j'z <br />J _! <br />Bucket Depth: <br />Q <br />13 `�Z- <br />12 /` <br />Wait time between applying <br />vacuum/water and start of test: <br />16 <br />Test Start Time (TO: <br />9 Cao <br />Initial Reading (Rj): <br />Test End Time (TF): <br />(b C3 0 <br />Final Reading (RF): <br />Test Duration (TF — TI): <br />F� <br />Change in Reading (RF - Rj): <br />Pass/Fail Threshold or <br />Criteria: <br />,Comments -- (include information on repai s adeprior o te ting, and recommended follow p r failed tests) <br />Wit= ►� 1 \ � <br />-� �" �"I^ 1=1- <br />PO L I <br />i \/ <br />Test Vater: Taken with tester 0 Lefton site <br />hereby certify that all the information contained in this report is true, <br />accurate, and in full com lian with legal requirements. Technician:. , Zane A. Nimmo <br />._, ICC #: 5263322 -UT <br />Signature: Y w- OTTL #: 04-1676 <br />