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C <br />416 2nd Street <br />Galt <br />�� C alifornia 95632 <br />209 744-0112 800 524-9087 FAX 2 <br />0 -vi ner/Contractor/EnR: TEST DATE: 7— <br />':JT;- <br />� Te: NAME, AAt <br />tg A s : 32z C.X ,$— A�j. Felix Ramirez <br />c <br />Phone: TECH SIGNATURE: f' <br />Operator Name: OTTL # 08-1740 ICC# 52739 -UT r <br />LEAK DETECTOR <br />116 TEST REPORT <br />ENVIRONMENTAL HEALTH AGENCY: <br />ren ®5�1 =4 I <br />® Present Not Present <br />INSPECTOR NAME: <br />LEAK DETECTOR KEY <br />LD2000 C FE Petro STP -MLD G Red Jacket FXIV <br />LD20001E D FE Petro STP -MLD -E H Red Jacket FXIVD <br />E FE Petro STP -MLD -D <br />F FE Petro STP -MLD -DE J Other <br />FTA LF,AK DFT1RrTn TIP .QT T1%T1 n121%4ATTniv Calibratedto <br />---------- <br />iu nm <br />Dispenser <br />Product <br />LD Key Serial # <br />Resiliency Opening Test Leak Rate <br />Functional Metering P F�j <br />!umber <br />Time <br />Element <br />�-7 <br />from above <br />inseconds ML per Minute <br />Holdin PSI Pass/Fail <br />P <br />16� <br />P/F <br />P/F <br />F <br />P/F <br />` <br />P/F <br />P/F <br />P/F <br />: <br />P/F,, <br />P/F <br />