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Ilk <br /> POB 36 26515 N. SACTO. B . <br /> AFFORDA-TE$T LINE TEST <br /> THORNTON, CA. 95686 <br /> 209 REPORT 794-0102 800 524-9087 <br /> TEST DATE —a3—'y' <br /> OWNER �. ,, A_)k t µ 61QG OPERATOR KLl.CG'Qf C01YG LO) d k <br /> PHONE a09 '341`af - 0193f/ PHONE <br /> ADDRESS // 7-(r �F_, SITE ADDRESS t7I <br /> i tea`/L <br /> CONTRACTOR/ENGINEER REASON FOR TEST <br /> ORDERING TEST <br /> LOCATION SKETCH----r-(1-P-$1­— <br /> LINE(S) <br /> KETC P-$1 «g onn <br /> LINE(S)ONLY <br /> LINE(S)-LEAK DET. ODD <br /> TANK(S)-LINE(S)-LEAK DET. <br /> TANK-LINE EM <br /> MAKE d TYPE OF PUA <br /> ORU S ENS R )( A n X -AA AX 9 K A A A K t Y S A X Y A 1( <br /> COVER OVER ` <br /> LENESGff ie\ <br /> APPRGX BUIUAL <br /> D �I <br /> WEATHER � I�LJIII <br /> LDol2 trHeFS <br /> fJbnvc arhwrm - <br /> SHOW STREETS,PLUGS,TANKS,ISLANDS,PIPING(IF KNOWNX PUMPS OR DISPENSERS <br /> OCERTIFICATION <br /> TECTOR LEAK DETECTOR TEST INFORMATION <br /> (CHECK) No. Serial Opening Test FEu�nctiomna�l Metering Yes/ <br /> Product Number Resiliency Time Leak Rate IIvle�nePSI PSI g No <br /> MLIMin 8 <br /> 116036-5 FI <br /> 11FLD(XL MOD <br /> 0 9- LL <br /> 116030-5 (� '2tC / " <br /> 116035-5 <br /> 116017-5 <br /> 116012-5 <br /> TRACTOR LINE TEST RESULTS <br /> IFICATION 7E'STS WFRFAIADE ON THE LINE SYSTELISASNOTED RV ACCORDANCE WITH TEST <br /> PROCEDURF_S PRESCRIBED FUR ASDETAII cn ONTHE TEST CHART ONSIDE 1 <br /> OF THISFORM WITH RESULTSASFOLLOWS: <br /> OTTL LIC N 91-1143 <br /> PETROTITE CERT.#090993A0163 LINE IDENTIFICATION NET VOLUME CHANGE PER HOUR <br /> U PASS % <br />