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06 / 28 / 2019 19 : 29 8387674 EMILS PAGE 18 <br /> AFORDA-TE$T Site Name : EMITS LIQUOR & SPORT SHOP <br /> Addre5s : 1405 CALIFORNIA ST <br /> 416 2nd Street City : ESCOLON CA ZIP : 95320 <br /> Gait, CA95632Facility Permit # : N-308 <br /> (209) 744 -0112 Fax (209 ) 744-0116 Date :6/27/ 18 Time : <br /> Technicians ED STEARNS Ex 2020 <br /> District Cert # : 0067 Ex Exp, <br /> 2019 <br /> Healy Cert # : 1009893706 P• <br /> Digital Manometer Calibration Date : 4/2/ 1$ <br /> HEALY TEST FORM <br /> Clean Air Separator Pressure Pyr an q e B g Tem <br /> Fuel Grade : ALL Nozzle Type :900 <br /> Initial Vacuum / Pressure prior to test Q WASS #7 # 13 # 19 #25 #31 <br /> t . Initial vacuum / Pressure CMCJ •2 ,07 #32 <br /> 2. Vacuum / Pressure after 1 minute, inches of waiter: 2,00 #'2PASS 08 # 14 #20 <br /> # 26 ' <br /> 3. Vacuum / Pressure after 2 minutes, inches or water; 2.00 #3PASS #9 # 15 # 21 #27 # 33 <br /> 4, vacuum / Pressure ager 3 minutes, inches of water: 1.99 #4PA5S # 10 # 16 # 22 #28 #34 <br /> 5 . Vacuum / Pressure after 4 minute% inches of water : 1.99 <br /> 6. vacuum / Pressure after 5 minutes, inches of water: 1 ,98 # 5 # 11 # 17 423 # 29 #35 <br /> 7 . Vacuum / Pressure otter 5 minutes, inches of water : 1 .50 # 214 # 30 # 36 <br /> #6 # 12 # 18 <br /> ® PASS ❑ FAIL <br /> I dedore, undGr�d In rn docry u d ore true, S of theStO10 Of <br /> t Ond Cdif tete. that hosed on information and belief formed orterreoaonoble inciviry, the statements and <br /> info(motion I) 0 <br /> Technician Signature, W// <br /> Received Time Jun . 28 , 2019 7 : 27PM No . 5223 <br />