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jNf f <br />CONTRACTOR/ENGINEER u <br />ORDERING TEST <br />SITE: <br />OPERATOR <br />SITE ADDRESS i Q�i fi ,� Tv c i <br />,e <br />PHONE <br />POs 36 26515 N. SACTO, BL. LINE & LEAD DETECTOR <br />THORNTON, CA. 95696 TEST REPORT <br />209 794-0102 800 524-9087 <br />, f lA) w 0 TEST DATE <br />►a <br />1-20° t 7a7 - <br />REASON FOR TEST <br />"" (I a / <br />L 4E(s) ONLY I TANK(s)-LINE(s <br />LINE(s)-LEAK DET. <br />1 TANKMPILINE(M-LEAK DET. <br />MARE &TYPE OF P <br />OR DISPENSER Tip hjj±(9tj <br />COVER OVER <br />MES <br />APPROX BURL4L <br />DEYIH <br />OWNER <br />ADDRESS <br />PHONE <br />LOCATION SKETCH )k <br />r S �� <br />++WN <br />U < 0j <br />CJS <br />M d <br />SUCTION <br />SHOW SIRESTs BLDOS TANK ISLAND <br />PIPING F KNO PUMPS OR DISPENSERS <br />LEAK DETECTOR <br />T <br />E <br />y <br />TYPES: <br />WEAMM a VYY[ <br />r S �� <br />++WN <br />U < 0j <br />PRESSjJRE <br />SUCTION <br />SHOW SIRESTs BLDOS TANK ISLAND <br />PIPING F KNO PUMPS OR DISPENSERS <br />LEAK DETECTOR <br />FTA LEAK DETECTOR TEST INFORMATION <br />E <br />y <br />TYPES: <br />No. <br />LD <br />1e'r <br />Serial <br />Number <br />Resiliency <br />open, <br />Time <br />JIM Seconds <br />Test <br />Leak ,Fate <br />ML/Afin <br />uns <br />Elet <br />Holding;S <br />Product <br />XLD P/N 116036-5� <br />1 Q <br />3-P) 4g aOJb <br />(,O <br />2yjrozy <br />J,3 <br />PLD PIN 116030-5 <br />XLP PIN 116035-5 <br />DLD P/N116017-5 <br />BFLD P/N 116012-5 <br />Notes <br />CONTRACTOR <br />CERTIFICATION <br />TECHMCL4N: YLE D. EVIMO <br />SiONA7VR8 � � <br />PETROTfft CERT. 0 090993A0163 <br />OTTL LIC # VT --1143 <br />I; <br />PSI <br />Calibrate <br />10 PSI <br />Yes/ <br />No <br />LINE TEST RESULTS <br />TESTS WEREMADEON MEUNE SMIWSASNOTED INACCORDANCE WITH TEST <br />PROCEDURESPRESCRIBED FOR AS DETAILED ON THE TEST CHART ONSIDE 2 <br />OF THIS FORM WITH RESULTS ASFI?LLOWS: <br />LINE IDENTIFICATION NET VOLUME EffA NGE PER HO <br />PASS / FAIL / INCONCLUSIVE ,p0 <br />PASS / FAIL / INCONCLUSIVE <br />PASS / FAIL / INCONCLUSIVE <br />PASS / FAIL / INCONCLUSIVE <br />