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fforda` 1 4162nd Street Phone:(209)744-0112 LINE & LEAK DETECTOR <br /> Galt,Ca 95632 Fax:(209)744-0116 TEST REPORT <br /> afforda@softcoro.net net <br /> CONTRACTOR/ENGINEER Elite IV Contractors <br /> SITE NAME Costco#38 TEST DATE 06/ 14/2012 <br /> (_) _ <br /> SITE ADDRESS 1616 E Hammer Lane PHONE <br /> CITY Stockton REASON FOR TEST: Repair <br /> XX Repair/Construction LOCATION SKETCH Show North <br /> ❑ Compliance❑Owners Request <br /> Insurance ❑ Escrow <br /> Other <br /> Make&Type of Pump or Dispenser <br /> Gilbarco/FE Petro <br /> Cover Over Lines <br /> Concrete <br /> Approx Burial Depth <br /> 36" <br /> Weather <br /> Warm <br /> XX5LEAKDETECTOR <br /> Suction SHOW STREETS,BLDGS,TANKS,ISLANDS,PIPING(IF KNOWN),PUMPS OR DISPENSERS <br /> FTA LEAK DETECTOR TEST INFORMATION C 0 PSIeOpening Test Leak I Element <br /> KEYS No/ LD Serial Resiliency Time In Rate Holding Metering Pass/ <br /> Product Ke Number Seconds ML/Min. PSI PSI Fail <br /> AB E <br /> C FXI V <br /> D FXI DV <br /> E STPMLD <br /> THF STPMLD — D <br /> G STPMLD — E <br /> STPMLD—D/E Notes: <br /> CONTRACTORLINE TEST RESULTS <br /> CERTIFICATION <br /> Technician: Lyle Nimmo Tests were made on the line systems as noted in accordance with test procedures <br /> prescribed for as detailed on the test chart on Side 2 of this form with results as follows: <br /> LINE IDENTIFICATION NET VOLUME CHANGE PER HOUR <br /> PETROTITE CERT.#: CCA: 0201029110 RU),. ❑PASS ❑FAIL ❑INCONCLUSIVE +,0040 <br /> ICC#5249115UT EX.6-30-11 []PASS ❑FAIL ❑INCONCLUSIVE <br /> OTTL License#: 90-1143 EX. 12-31-12 <br /> ❑PASS ❑FAIL ❑INCONCLUSIVE <br /> ❑PASS ❑FAIL ❑INCONCLUSIVE <br /> EQUIPNIIENT: PETRO TITELME TESTER ❑PASS ❑FAIL ❑INCONCLUSIVE <br />