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T 4162 n1 S Phone: (209)744-0112 LINE & LEAK DETECTOR <br /> orda- 1 t Galt, Ca Fax: (209)744 016 TEST REPORT <br /> 4rIalo4yr�,a@softcom.net <br /> CONTRACTOR/ENGINEER SSS <br /> SITE NAME:SJ RTD TEST DATE 09-23-10 <br /> SRN JOi�,OU;�;COUNTY <br /> SITE ADDRESS 1533 E LINDSAY ST ENVIF;C!\ ,' NTAL <br /> CITY STOCKTON CA HEALTH DER;RTMENT PHONE (209) 943 - 1111 <br /> Repair/Construction LOCATION SKETCH Show North f— <br /> ® Compliance El Owners Request <br /> O <br /> Lj Insurance Escrow 0 0 O 0 O <br /> Other <br /> Make&Type of Pump or Dispenser O O O O O <br /> TOKHEIM O 0 O <br /> Cover-Over Lines O <br /> CONCRETEC: —6 <br /> O <br /> O <br /> Approx Burial Depth <br /> 30' O <br /> PV VENTS <br /> Weather nCAS DIE R DIE <br /> SUNNY 0 0 <br /> Pressure SUCfIOn SHOW STREETS,BLDGS,TANKS,ISLANDS,PIPING(IF KNO N),PUMPS OR DISPENSERS <br /> Calibrate <br /> LEAK DETECTOR FTA LEAK DETECTOR TEST INFORMATION to PSI <br /> Opening Test Leak I Element <br /> KEY TYPES No/ LD Serial Resiliency Time In Rate Holding Metering Pass/ <br /> Product Key Number Seconds ML/Min. PSI PSI Fail <br /> A LD 2000 <br /> B LD 2000 E <br /> C FXI V <br /> D FXI DV <br /> E STPMLD <br /> F STPMLD — D <br /> G STPMLD — E <br /> H STPMLD—D/E Notes: <br /> CONTRACTOR LINE TEST RESULTS <br /> CERTIFICATION <br /> Technician: Tests were made on the line systems as noted in accordance with test procedures <br /> +r C�t}.�ZRYY It Yrz" 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.N: CCA: DIE ®PASS ❑FAIL ❑INCONCLUSIVE ,0010 <br /> OTTL License N: ..,,. 01 11 4b <br /> DIE ®PASS FAIL FNCONCLUSIVE ,0010 <br /> Trainee: Vb RUL ZPASS FAIL INCONCLUSIVE .0010 <br /> PASS FAIL EIINCONCLUSIVE <br /> EQUIPMENT: PETRO TITELINE TESTER EIPASS FAIL LIFNCONCLUSIVE <br />