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416 2nd Street Gait CA 95632 LLE & LEAK DETECT'OFP <br /> AFFoRDA® (209) 744-0112 (209) 744-011E FAX TEST REPORT <br /> CONTRACT R/ENGINEER TEST DATE <br /> SITE NAME ,4 S f-&k-7,1 r�or (i S , PHONE ( ) <br /> v <br /> ADDRESS TZC� <br /> '4�--r e v'i p E? V l yj <br /> Compliance LO ATION SKETCH Show North <br /> Repair/Construction <br /> Insurance <br /> Escrow <br /> Make&Type of Pump or Dispenser <br /> c)wk ( <br /> Cover Over Lin s <br /> Ce) via �eff <br /> Approx Burial 69pth <br /> Ato <br /> Weather <br /> `rt <br /> k° Pressure Suction SHOW STREETS,BLDGS,TANKS,ISLANDS,PIPING(IF KNOWN),PUMPS OR DISPENSERS <br /> Calibrated to 3 gph @ 10 psi FTA LEAK DETECTOR TEST INFORMATION Calibrate <br /> 0 PSI <br /> LEAK DETECTOR KEY Disp#/ LD opening Leak Functional <br /> Time Rate Element Metering <br /> Product Key Serial Number Resiliency In seconds MUMln Holding PSI PSI Pass/Fail <br /> A LD 2000 P / F <br /> B LD 2000 E - P / F <br /> C FXI V P / F <br /> D FXI DV P / F <br /> E STPMLD p / F <br /> F STPMLD - D P / F <br /> G STPMLD - E P / F <br /> H STPMLD- D/E Notes: <br /> CONTRACTOR LINE TEST RESULTS <br /> CERTIFICATION Tests were made on the line systems as noted in accordance with test procedures <br /> Technician:Lyle D Nlmmo 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 /> PET66TITE CERT# T5 4 , PASS / FAIL / INCONCLUSIVE <br /> 090993AO163 <br /> OTTLLic#97-1143 PASS / FAIL / INCONCLUSIVE <br /> Trainee: PASS / FAIL / INCONCLUSIVE <br /> PASS / FAIL / INCONCLUSIVE <br /> EOUIPMENT:PETRO TI FELINE TESTER <br />