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' <br />/.,--Te$t <br />POB 36 26515 N. Sacramento Blvd. <br />Thornton, California 95686 <br />(209) 794-0102 (800) 524-9087 FAX(209)794-0112 <br />Static Torque & Rotation <br />Drop Tube Pressure Integrity <br />�q <br />Contractor /Engineer Ordering Test (ifany): <br />TEST DATE: C) <br />TIME: �0,A <br />SITE NAME, f C n <br />Operator Name: <br />Start Annual <br />Owner: <br />TECfMCIANNANE: <br />" <br />T),Pi ui D 1,J 1\)r- t, E R <br />TECH SIGNATURE: <br />Site Address: L) '- ini'��/''Tt�r''�/� v <br />Address: <br />AIR QUALITY AGGNCYSJ A 01 ry\D <br />1 <br />INSMCTORNAME: <br />Present Not Present <br />nnnn ? O 6 <br />_P�r -jD �•')/ <br />i <br />Phone: 7) - 6 M E- <br />�f0 <br />FACILITY INFORMATION <br />A/C, Application, <br />or Permit# <br />Gasoline Disp <br />Facility 9 <br />��ll{� '''. ll � <br />Phase I Type OW 1" W ( <br />Phase II Type I, I A <br />STATIC TORQUE & ROTATION <br />lb " <br />iQ <br />lb ' <br />DROP TUBE PRESSURE <br />INTEGRITY <br />(.16 & under is Pass) <br />Ya xA�la to"r4 ` , <br />1 <br />2- <br />3 <br />4 ; <br />Prndait <br />Grade <br />�} <br />Nltr6ief <br />Flo�vrate <br />` CFII <br />i'ressure <br />(inches of <br />Water <br />,.MakelMotlel� <br />Spill Il40it <br />t <br />Gontaitttfienf s <br />ltlalie/Madel' <br />„<- otatable <br />ProductXan o <br />pt <br />;{ <br />o e <br />o stable <br />VprAdaptor <br />Bend: <br />Model: <br />Prod. Grade: <br />Torque#1: <br />%S— <br />60 <br />wNo <br />/110 <br />-?Lf fc t o <br />'.rorque#2: <br />7 <br />Torque #3: <br />Avera <br />360"Rotation: <br />es / No <br />es / No <br />Yes / No <br />Yes / No <br />/(/7 <br />Sic n <br />ProdictAclnptor' <br />Brand: <br />'rb1 <br />"` <br />..2.;: <br />x <br />Comments <br />Model: <br />ProductGrade: <br />�� <br />7 <br />Torque#1: <br />hS <br />(alb <br />Torque #2: <br />7� <br />U <br />'torque #3: <br />AverngT: <br />YeS / NO <br />tt <br />tYes NO <br />Yes / No <br />YES• .10 <br />F1owMeter.Calibration ��i t l� Pressure Device Calib. n'I C ) <br />360')Rota► <br />