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AFFORDA <br />4162 nd Street Galt, C . 95632 <br />Tank #4Tank## <br />AST PAN K TEST <br />209 744-0112 Fax 209 744-0116 <br />Tank Capacity: <br />Site: ;` <br />Test Date: <br />Product Stored:�,.t <br />Address: - <br />Cita': ! <br />Equipment: <br />r mes S <br />V <br />Test Method Developed By: Tank Manufacturer <br />' Industry Standard Professional Engineer <br />Other (Speck): <br />Initial Reading (Ri): <br />Test Method Uses: Pressure �_ <br />Vacuum Hydrostatic <br />Citite'Y"ISpecify'}: <br />Final Reading (Rf): <br />Measuring Equipment Used for Testing: <br />Test Duration: <br />p+ <br />a , r : r ► r % .4l fJL dC Y <br />Comments — (include information on repairs t`7.1ade to testing) <br />Technician: Lyle D. Nimmo [CC 95249115 -UT ExV. 07/01/09 <br />,/:7f — "'-" '. ' N I - 4 <br />Date: <br />(J <br />Tank #4Tank## <br />Tank # <br />Tank # <br />Tank Capacity: <br />Tank Material: <br />Product Stored:�,.t <br />Wait time between applying <br />Pressure/vacuum/ water and starting <br />test: <br />Test Start Time: <br />Initial Reading (Ri): <br />Test End Time:� <br />Final Reading (Rf): <br />Test Duration: <br />p+ <br />Change in Reading (Rf-Ri): <br />y� <br />Pass/Fail Threshold: <br />Test Result:GYS <br />Was sensor removed for testing? <br />Was sensor properly replaced after <br />testing? <br />Comments — (include information on repairs t`7.1ade to testing) <br />Technician: Lyle D. Nimmo [CC 95249115 -UT ExV. 07/01/09 <br />,/:7f — "'-" '. ' N I - 4 <br />Date: <br />(J <br />