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A&�rda,—Te <br /> 4162°a Street Phone: (209)744-0112 LINE & LEAK DETECTOR <br /> Galt,Ca 95632 Fax: (209)744-0116 TEST REPORT <br /> afforda@softcom.net <br /> CONTRACTOR/ENGINEER TEST DATE 02-05-2021 <br /> SITE NAME DAMERON HOSPITAL PHONE (209) 944 - 5550 <br /> SITE ADDRESS 525 ACACIA AVE STOCKTON CALIFORNIA CITY STOCKTON CA 95203 <br /> ❑ Repair/Construction LOCATION SKETCH Show North <br /> ® Compliance <br /> Insurance <br /> Escrow <br /> Make&Type of Pump or Dispenser <br /> REDJACKET <br /> Cover Over Lines <br /> CONCRETE <br /> Approx Burial Depth <br /> 36' <br /> Weather <br /> SUNNY <br /> ® Pressure Suction SHOW STREETS,BLDGS,TANKS,ISLANDS,PIPING(IF KNOWN),PUMPS OR DISPENSERS <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 I STPMLD—D/E Notes: <br /> CONTRACTOR LINE TEST RESULTS <br /> CERTIFICATION <br /> Technician: Tests were made on the line systems as noted in accordance with test procedures <br /> prescribed for as detailed on the test chart on Side 2 of this form with results as follows: <br /> FELIX RAMIREZ LINE IDENTIFICATION NET VOLUME CHANGE PER HOUR <br /> PETROTITE CERT.#: 3130 RED DIE PASS -.0020 <br /> CCA: 5273934-ut <br /> OTTL License#: 08-1740 PASS/FAIL/INCONCLUSIVE <br /> Trainee: PASS/FAIL/INCONCLUSIVE <br /> JOSH POWELL <br /> PASS/FAIL/INCONCLUSIVE <br /> EQUIPMENT: PETRO TITE LINE TESTER <br />