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Ver. 1.3 – 08.07.09 <br />TP 201.3 <br />UST Static Pressure Performance Test Report Form <br />Permit Number: Test Company: <br />Site Name: Technician: <br />Site Address: Certification Number Expiration Date <br />City: Zip: District: <br />Date/Time of Test: <br />TEST INFORMATION <br />Total number of nozzles: Are the tanks manifolded? Yes No <br />Phase I vapor recovery system executive order (as referenced on Permit to Operate) <br />Phase II vapor recovery system executive order (as referenced on Permit to Operate) <br />Nitrogen introduction point Phase I vapor coupler Phase II vapor riser <br />Pressure measuring device incline manometer digital manometer mechanical gauge <br />Calibration date for pressure measuring device (must be within 90 days of the test) <br />Ending value for digital manometer drift test if applicable (must be 0.01 in. w.c. or less) <br />Initial tank ullage pressure (vent if over 0.5 in. w.c.) <br />Nitrogen introduction flow rate, F (must be between 1 and 5 CFM) <br />Calculated ullage fill-time, t2 (t2 = V / 1522 x F) <br />Actual fill-time <br />Number of hoses with over 100 ml (balance hoses must be drained prior to testing) <br />TANK INFORMATION <br />Tank No. 1 2 3 4 ALL <br />Product grade <br />Actual tank capacity (gallons) <br />Gasoline volume (gallons) <br />Ullage, V (gallons) <br />If tanks are not manifolded, number of nozzles <br />2 IN. W.C. STATIC PRESSURE TEST <br />Test No. 1 2 3 4 5 <br />Start time <br />Initial Pressure, inches of water column (in. w.c.) <br />Pressure at one minute, in. w.c. <br />Pressure at two minutes, in. w.c. <br />Pressure at three minutes, in. w.c. <br />Pressure at four minutes, in. w.c. <br />Pressure at five minutes, in. w.c. <br />Allowable minimum pressure, in. w.c. <br />Pass / Fail (enter “GF” for gross failure) <br />I declare, under penalty of perjury under the laws of the state of California that based on information and belief formed <br />after reasonable inquiry, the statements and information provided in this document are true, accurate, and complete. <br />Signature of Technician: ________________________________ Date: ____________________ <br />Jones Covey Group <br />Pilot Flying J 618 Ripon Shawn Rodriguez <br />1501 N. Jack Tone Rd. <br />Ripon 95366 SJV-0308 06/30/2025 <br />09/19/2024 @10:45am <br />16 <br />VR-101 Phil-Tite <br />VR-204 Balance <br />07/11/2024 <br />0.00" w.c. <br />0.23" w.c. <br />2 CFM <br />2 Mins 41 Sec <br />2 Mins 18 Sec <br />0 <br />87 91 T1-T2 <br />11,849 11,849 23,698 <br />7027 8491 15,518 <br />4822 3358 8,180 <br />N/A N/A N/A <br />10:45am <br />2.00" w.c. <br />2.01" w.c. <br />2.02" w.c. <br />2.03" w.c. <br />2.04" w.c. <br />2.05" w.c. <br />1.81" w.c <br />Pass <br />09/19/2024