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0 0 <br /> AFF®R®A-TE$ A 416 2nd Street Galt CA 95632LTEST <br /> Spill B5C) <br /> (i (209) 744-0112 (209) 744-0116 FAXrest R <br /> ATE '2 - ;t <br /> SITE NAME <br /> ADDRESS c� 1 CONTACT: h 0vM c <br /> Inspector: M U Vl G U tV ( Present ! Not Present <br /> J <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ViIydrostatic D Vacuum ❑Other <br /> Test Equipment Used: Equipment Resolution: <br /> Identify Spill Bucket(By Tank 1l > 4 <br /> Number,Stored Product, etc. T�Q L z 3 <br /> Bucket Installation Type: Direct Bury irect Bury EXirect Bury D Direct Bury <br /> ❑Contained in S M-1Contained in S D Contained in S D Contained in S <br /> Bucket Diameter: 12- i 2 12- <br /> Bucket <br /> ZBucket Depth: I -2 l y <br /> Wait time between applying _ <br /> vacuum/water and start of test: " <br /> Test Start Time Ti <br /> d (Tj) .) 0 2- 10•a(a l l7 ' 2 7 <br /> Initial Reading(Rj): 9 A ' <br /> Test End Time(TF): 0 2� I L ( 0 2�/ <br /> Final ReadingI <br /> (RF)� � tt <br /> Test Duration(TF-Tj): a v y' V'Y,. n a V <br /> Change in Reading(RF-RO: <br /> Pass/Fail Threshold or <br /> Criteria <br /> a�, i�➢4�.C�.'.� <br /> COMMentS - (include information on repairs made prior to testing and recommended ollow-up forfaded tests) <br /> Test Water: Taken with tester Left on site <br /> hereby certify that all the information contained in this report is true\ <br /> iccurate, and in full compliance with legal requirements. Technician:' Lyle D. Nimmo <br /> g cl /1 J� ICC#: 5249115-UT <br /> 3i nature: ( / uL2 OTTL#: 97-1143 <br />