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4162"d Street Phone:(209)744-0112 Galt,Ca 95632 Fax. (209)744-0116 afforda softeom.net E.O. VR-202 Veeder-Root In-Station Diagnostics Vapor Pressure Sensor Reference Test & Site Shutdown Test Report Form Permit Number: N-3466 CONF# 12-14963 Test Company:AFFORDA-TEST Site Name: GEORGE'S MINI MART Technician: Zane A.Nimmo Site Address: 18662 N. HWY 88 Certification Number Expiration Date City: LOCKEFORD Zip:95237 District:#0083 Date/Time of Test: 5/15/12 Veeder-Root:A28446 8/11/2012 VAPOR PRESSURE SENSOR UST PRESSURE TEST Calibration date for digital manometer(must be within 12 months of the test) 4/11/12 Ending value for digital manometer drift test(must be 0.01 in. w.c,or less) ,00 Digital manometer ullage pressure,inches of water column(in. w.c.) 2,07 TLS console pressure sensor value, inches of water column(in. w.c.) 2.055 Is pressure value between-0.20 and+0.20 in. w.c.? PASS VAPOR PRESSURE SENSOR AMBIENT REFERENCE TEST 1,2 Pressure sensor located at dispenser number(s) 1/2 Pressure sensor number 6008 Non-calibrated pressure sensor value,inches of water column(in. w.c.) -0,028 Is pressure value between-0.20 and+0.20 in.w.c.? PASS SITE SHUTDOWN TEST Test Parameter Test Result(Y/N) Was power removed from the TLS-350 console? Y Was power to the submersible pump(s)removed by the TLS-350? Y Was power restored to TLS-350 console? Y COMMENTS (Include Description of Repairs Made) NOTES: Valve must be returned to normal operating position after testing is completed. 2The ambient reference port cap must be in place after testing is completed. 3A certified Veeder-Root technician must perform this test. I declare, under penalty of perjury under the laws of the state of California that based on information and belief formed after reasonable inquiry, the statements and information provided in this document are true, accurate, and complete. Signature of Technician: Date: 5115/12