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ftrla—Te <br /> 4162"d Street Phone: (209) 744-0112 LINE & LEAK DETECTOR <br /> AGalt, Ca 95632 Fax: (209)744-0116 TEST REPORT <br /> afforda@softcom.net <br /> CONTRACTOR/ENGINEER DATE8/25/23 <br /> SITE NAME: SAN JOAQUIN HOSPITAL <br /> SITE ADDRESS 500 HOSPITAL RD <br /> CITY FRENCH CAMP CA <br /> ❑ Repair/Construction LOCATION SKETCH Show North <br /> ❑ Compliance ❑ Owners Request <br /> Insurance ❑ Escrow <br /> Other <br /> Make&Type of Pump or Dispenser <br /> Cover Over Lines <br /> CONCRETE <br /> Approx Burial Depth RED JACKET <br /> 45 inches <br /> Weather <br /> SUNNY <br /> ® I 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 /> Dave 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 CERT.#: CCA:02030328110 DSL ®PASS ❑FAIL ❑INCONCLUSIVE _.0000 <br /> OTTL License#:08-1740 <br /> Trainee: <br /> EQUIPMENT: PETRO TITE LINE TESTER <br />