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nucleus pump services <br /> np5 601 1st Ave , Suite B <br /> Sacramento , CA 95818 <br /> TP -201 . 6C Or EVR Liquid Removal Test Phone : 916 - 3824761 <br /> Liquid Removal Rate Report Form Fax: 707 - 638 - 0484 <br /> Permit Number: Test Company : Nucleus Pump Services <br /> Site Name : CHEVRON Technician: Chris Bishop <br /> Site Address : 10878 N , HWY 99 Certification Number : Expiration Date : <br /> City: STOCKTON Zip : 95212 District: 8216429 5/4/2020 <br /> Date/Time of Test: 10/2/2019 10 : 00 AM VST ( if applicable) : 3000965405 8/9/2020 <br /> TEST INFORMATION <br /> Phase II vapor recovery system executive order: ❑ &7M2 (Pre-Phase II EVR balance for AST & UST) ❑ VR-203 /204 (VST Phase II EVR balance) <br /> EVR Short VI G T Dispensing VF Wi Wr VW VI — VW —VF <br /> Nozzle Fuel Version * * Rate G <br /> Volume of Time to Gas drained Gas introduced Pass / Fail <br /> Number Grade Gas drained Gas added to hose Gallons dispense G x 60 after after dispensing Gas Wi wr Liquid removal <br /> from hose (ml) ( 150 — 175 ml) dispensed (sec.) T dispensing ( 150 — 175 ml ) recovered rate (ml/gal) <br /> I declare, under penalty of perjury under the laws of the state of California that based on information and belief formed after reasonable inquiry, the <br /> statements and information provided in this document are true, accurate, and complete. <br /> Signature of Technician : C / �05 Date : 10/2/2019 <br /> kx NOTE : For EVR systems — Prior to the Leak Decay Test, if the liquid drained from the hose is <25 ml , record the amount in the EVR short <br /> version column , mark the test as pass , and no further testing is required . <br /> Ver. 1 .5 — 03. 20 . 14 <br />