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416 2nd Street Galt CA 95632 I LINE & LEAK DETECTOR <br /> /Qt�F��►�/�l-Ti��� � {209} 744-0112 FAX (209) 744-011L--j <br /> TEST REPORT <br /> CONTRACTOR/ENGINEER /— -0 y <br /> TEST PATE <br /> SITE NAME Loot*H hCr -z 4- PHONE ( ) <br /> ADDRESS ' C�t7-C) l vtC. "I �` C!10 f � <br /> 4 <br /> Repair/Construction LOCATION SKETCH <br /> Show North <br /> Compliance <br /> Insurance <br /> Escrow <br /> ake&Ty e of Rum o Dispe ser <br /> :,�_ 1'�'a OT _ 1% , <br /> Cover Over Lines <br /> J, . 1'P7 <br /> Approx Burial Depth <br /> If� <br /> Weather <br /> Pressure X SUCtIOC] ISHOW STREETS, BLDGS,TANKS, ISLANDS,PIPING (IF KNOWN), PUMPS OR DISPENSERS <br /> LEAK DETECTOR FTA LEAK DETECTOR TEST INFORMATION Calibrate <br /> Opening I Element 10 PSI <br /> LD Serial Time In Test Leak Holding Pass 1 <br /> KEY TYPES No/Product Key Number Resiliency Seconds Rate MUMin PSI Metering PSI Fail <br /> A LD 20001,. : <br /> B LD 2000 E <br /> D FXI DV <br /> FE_ STPMLD <br /> F STPMLD- D <br /> G STPMLD - E <br /> H STPMLD - DIE Notes:CONTRACTOR LINE LINE TEST RESULTS <br /> CERTIFICATION Tests were made on the line systems as noted in accordance with test procedures <br /> Technician:Lyle D. Nimmo 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 /> P RATITE CERT# t4 k a PASS FAIL / INCONCLUSIVE • Q O <br /> 090993AO163 OTTL <br /> Lic#97-1143 / FAIL / INCONCLUSIVE <br /> Trainee-. =' ; PASS FAIL / INCONCLUSIVE <br /> / FAIL / INCONCLUSIVE <br /> EQUEPIv�ENT:RETRO TITE LINE TESTER <br />