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fforda-Te t 4162"d Street Phone: (209)744-0112 LINE & LEAK DETECTOR <br /> Galt,Ca 95632 Fax: (209)744-0116 TEST REPORT <br /> sandi@affordatest.com <br /> CONTRACTOR/ENGINEER TEST DATE 8/19/2022 <br /> SITE: SAN JOAQUIN GENERAL HOSPITAL <br /> 500 W. HOSPITAL ROAD STOCKTON , CA 95231 <br /> ❑ I 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 In Lieu Of Shutdown <br /> Make&Type of Pump or Dispenser <br /> RED JACKET <br /> Cover Over Lines <br /> CONCRETE <br /> Approx Burial Depth <br /> 2 - 5 FEET <br /> Weather <br /> SUNNY , WARMING <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 DSL NONE IN- STALL -ED <br /> G STPMLD — E <br /> H STPMLD—D/E Notes:NO LEAK DETECTOR ON SITE <br /> CERTIFICATION: <br /> CALIFORNIA: I declare under penalty of perjury that testing was done by a licensed tank tester in the State of California and the information in this report <br /> true and correct to the best of my knowledge. <br /> NEVADA: I hereby certify that I am responsible for the services described in this document and for the preparation of this document.The services described in <br /> this document have been provided in a manner consistent with the current standards of the profession and to the best of my knowledge comply with <br /> all applicable federal,state and local statutes,regulations and ordinances. <br /> Technician: PETROTITEN:8D892F5F 3/7/24 ICC#8883064 UT 7/20/23 OTTL License#:04-1676 4/30/25 Nevada UT-2206 9/20/23 <br /> Zane A.Nimmo LINE TEST RESULTS <br /> Tests were made on the line systems as noted in accordance with test procedures <br /> pr scribed 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 /> EQUIPMENT: ❑PASS ❑FAIL ❑INCONCLUSIVE <br /> PETRO TITE LINE TESTER ❑PASS ❑FAIL ❑INCONCLUSIVE <br /> Trainee: RED DIESEL ®PASS ❑FAIL ❑INCONCLUSIVE -.0020 <br /> ❑PASS ❑FAIL ❑INCONCLUSIVE <br />