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AFFORDA-T. T <br /> 4162 d Street Galt,Ca. 95632 AST TANK TEST <br /> ' 209 744-0112 Fax 209 744-0116 <br /> Site: 11,�, 0 n y i fyv 1 Y► e r- Test Date: f / Cr /d) <br /> Address: 1 J4 pp �E , V, G�r— d, <br /> City: Ld,7 oe ?5z-'9D Equipment: L g u I s <br /> D � <br /> Test Method Developed By: Tank Manufacturer Industry Standar 1 , <br /> Other(Spec): <br /> Test Method Uses: Pressure Vacuum ENVIIdI (NEALTH <br /> (specify):. PERMIT/jRRVICES <br /> Measuring Equipment Used for Testing: <br /> Tank# Tank# Tank# Tank# <br /> Tank Capacity: <br /> Tank Material: <br /> Product Stored: <br /> Wait time between applying <br /> Pressure/vacuum/water and starting <br /> test: <br /> Test Start Time: <br /> Initial Reading(Ri): 6Vr <br /> Test End Time: 3 0 <br /> Final Reading Rf): 3 5 f <br /> Test Duration: <br /> Chane in Reading Rf-Pj <br /> Pass/Fail Threshold: <br /> Test Result: �- <br /> Was sensor removed for testing? <br /> Was sensor properly replaced after it <br /> testing? V <br /> Comments — (include information on repairs made to testing) <br /> Technician: Lyle D. Nimmo ICC`#5249115-UT Exp. 07/01/09 <br /> Signature: Date: <br /> G�' <br />