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fforda - Te t 4162 Street Phone : (209) 744-0112 LINE & LEAK DETECTOR <br /> Galt, Ca 95632 Fax : (209) 7444116 TEST REPORT <br /> CONTRACTOR/ ENGINEER Elite IV TEST DATE 3/22/2019 <br /> SITE : WATERLOO FOOD MART <br /> 4315 E WATERLOO RD <br /> STOCKTON , CA 95215 <br /> ® Repair/Construction LOCATION SKETCH Show North <br /> Compliance ❑ Owners Request <br /> Insurance Escrow SHOW STREETS , BLDGS , TANKS , ISLANDS , PIPING (IF KNOWN) , PUMPS OR DISPENSERS <br /> Other ;{ <br /> it <br /> Make & Type of Pump or Dispenser <br /> FE PETRO Zb <br /> Cover Over Lines <br /> CONCRETE <br /> Approx Burial Depth <br /> 3 FT . ENVIRONIVI4= IWTAL i 1LJ > LT <br /> D ;^ PAI ITIVlE J <br /> Weather <br /> COOL <br /> Pressure ® Suction <br /> Calibrate <br /> LEAK DETECTOR FTA LEAK DETECTOR TEST INFORMATION 10 PSI <br /> Opening Test Leak I Element <br /> KEY TYPES No/ LD Serial Resiliency Time In Rate Holding Metering Pass/ <br /> Product Key Number Seconds ML/Min . PSI PSI Fail <br /> A LD 2000 <br /> B LD 2000 E <br /> C FXI V <br /> D FXI DV <br /> E STPMLD <br /> F STPMLD — D <br /> G STPMLD — E <br /> H STPMLD— D/E Notes : <br /> CONTRACTOR <br /> CERTIFICATION LINE TEST RESULTS <br /> Technician • Tests were made on the line systems as noted in accordance with test procedures <br /> DAVID WINKLER prescribed for as detailed on the test chart on Side 2 of this form with results as follows: <br /> LINE IDENTIFICATION NET VOLUME CHANGE PER HOUR <br /> PETROTITE f27318b2 11 /10/19 . ❑ PASS ❑ FAIL ❑ INCONCLUSIVE <br /> # : CCA0202112304R 87 OCT . 0000 <br /> ICC# 8883059-UT ® PASS ❑ FAIL ❑ INCONCLUSIVE <br /> OTTL License #: 0& 1739 3 -31 -20 <br /> Trainee : 91 OCT ® PASS ❑ FAIL ❑ INCONCLUSIVE . 0000 <br /> PASS ❑ FAIL ❑ INCONCLUSIVE <br /> EQUIPMENT: PETRO TITE LINE ❑ PASS ❑ FAIL ❑ INCONCLUSIVE <br /> TESTER <br />