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I♦ <br /> 416 2nd Street Galt CA 95632 Spill Bucket <br /> 9F® ® -TT (209) 744-0112 (209) 744-0116 FAX Test Report <br /> nn TEST DATE I <br /> SITE NAME p ( WE><" Fas-r-N-E.aS #(oU PHONE ( jaq ) q31 <br /> ADDRESS 108 CONTACT: 1\1A7 <br /> 5196L1-T/ CX 9-5ZlZ <br /> � <br /> Inspector: /d U/ 1 p Present / Not Present <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: PI H drostatic D Vacuum ❑Other <br /> Test Equipment Used: -7�APk LU Equipment Resolution: <br /> Identify Spill Bucket(By Tank 1 2 3 4 <br /> Number, Stored Product, etc.) 91 D 1 F- <br /> Direct Bury IRDirect Bury ®,Direct Bury ®,Direct Bury <br /> Bucket Installation Type: D Contained in Sump D Contained in Sump D Contained in Sump D Contained in S <br /> ump <br /> Bucket Diameter: 12 l 12 <br /> Bucket Depth: 13 I 13 <br /> 1 Wait time between applying <br /> vacuum/water and start of test: <br /> Test Start Time(TO: 15 1415 1 L4 15 <br /> Initial Reading(Rj) I 1 �lz I I- ( rj t 134 <br /> Test End Time(TF): 5 1 I rD 1 <br /> Final Reading(RF): l z f 5 t I s <br /> Test Duration(TF-TO: <br /> Change in Reading(RF-RO: _g _ — <br /> Pass/Fail Threshold or <br /> Criteria: <br /> Comments -(include informadoh on repairs made prior to testing, and recommen e"w-upd tests) <br /> Test Water: 7Taken with tester fZ?11-efon site S&v-Ae �r e�-Tq I <br /> I hereby certify that all the information contained in this report is true, <br /> accurate, and in full compliance with legal requirements. Technician:, Zane A. Nirltrno <br /> ICC#: 5263322-UT <br /> Signature: OTTL#: 04-1676 <br />