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AFFORDA-TE $T Site Name : QUICKI - KLEEN CAR WASH _ <br /> 416 2nd Street AddressN707 E YOSEMITE AVE <br /> Galt, CA 95632 City : MANTECA CA Zip : 95336 <br /> ( 209 ) 744- 0112 Fax ( 209 ) 744-0116 Facility Permit # : N - 643 <br /> Date : 05- 29 - 19 Time : 900 <br /> Technician : FELIX RAMIREZ <br /> District Cert # : 0099 Exp . 2020 <br /> Healy Cert # : 1009883708 Exp , 2021 <br /> Digital Manometer Calibration Date : 03 - 01 - 19 <br /> HEALY TEST FORM <br /> Clean Air Separator Pressure Performance Test Nozzle Bag Test <br /> Fuel Grade : <br /> Nozzle Type : <br /> Initial Vacuum / Pressure prior to test ❑ - ® + <br /> # 1 # 7 # 13 # 19 # 25 # 31 <br /> 1 . Initial Vacuum / Pressure (W . c. ) 2 . 0 <br /> 2 . Vacuum / Pressure after 1 minute, inches of water : 2 . 0 # 2 # 8 # 14 # 20 # 26 # 32 <br /> 3 . Vacuum / Pressure after 2 minutes, inches of water : 2 . 05 <br /> # 3 # 9 # 15 # 21 # 27 # 33 <br /> 4 . Vacuum / Pressure after 3 minutes, inches of water : 2 . 10 <br /> S . Vacuum / Pressure after 4 minutes, inches of water : 2 . 17 #4 # 10 # 16 # 22 # 28 # 34 <br /> 6 . Vacuum / Pressure after 5 minutes, inches of water: 2 . 23 <br /> # 5 # 11 # 17 # 23 # 29 # 35 <br /> 7 . Allowable final vacuum : 1 . 77 <br /> ® PASS ❑ FAIL # 6 # 12 # 18 # 24 # 30 # 36 <br /> 1 declare, under penalty of perjury under the laws of the state of California that based on information and belief formed after reasonable inquiry, the statements <br /> and information provided in the document are true, accurate, and complete . <br /> Technician Signature : <br />