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�4��4RDA-TAT(209) nd Street Galt C.4 95632 Splll Bucket <br /> 44-0112 (209) 744-031 16 FAX Test Report <br /> ------------- <br /> TEST DATE -- J <br /> SITE NAME Utiles - ' <br /> PHONE.( ) <br /> ADDRESS <br /> u CONTACT: <br /> �} <br /> Inspector: <br /> Present 1 Not Present <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ❑Hydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used: Equipment Resolution: <br /> Identify Spill Bucket(By Tank 1 2 <br /> Number, Stared Product, etc.) 4 <br /> Bucket Installation Type: erect Bury erect Bury ❑Direct Bury El Direct Bury <br /> Bucket Diameter: <br /> Q Contained in S Q Contained in Sum 11Contained in S Q Contained in SUER <br /> t � � <br /> Bucket Depth: )l <br /> Wait time between applying <br /> vacuum/water and start of test: i <br /> Test Start Time(Tr): <br /> Initial Reading(Rj): Q_(A r <br /> Test End Time(TF):- <br /> Final <br /> TF):Final Reading(RF): <br /> 7 CJ'�T<ss <br /> Test Duration(TF—Tr): t-- <br /> Change in Reading(RF-RD: — <br /> Pass/Fail Tlveshold or �r r/ f <br /> Criteria: f <br /> :a 4 <br /> .,,•. ,��_w, ,.. :� ,., . .,;`�,�„�?�' ..� :�,t,,• Piss „ ..,.,.�. <br /> I'assC]I all. <br /> Comments--(include information on repairs made prior to testing, and recommended follow-u for failed tests) <br /> Test Water: Taken with tester Left on site <br /> hereby certify that all the information contained in this report is true, <br /> accurate, and in l=ull compliance with legal requirements. <br /> Technician: Lyle D. NimrTlo <br /> ICC#: 5249115-UT <br /> signature: LI.� er <br /> OTTL#: 97-1143 <br />