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® 416 2nd Street Galt CA, 95632 Spill LIc et <br /> F F O R DA- T (209) 744-0112 (209) 744-0116 FAX Test Report <br /> TEST DATE g Z p <br /> SITE NAME leoi eep YAW4, PHONE <br /> ADDRESS 1331 j , Ll h-,_ Lw CONTACT- <br /> e�t4rs <br /> GI5-Z`fZ <br /> Inspector: S q 0 ri v,x tv CC) --Fc C, Present / Not Present <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: JX Hydrostatic 0 Vacuum 0 Other <br /> Test Equipment Used: y Equipment Resolution: t " <br /> Identify Spill Bucket(By Tank 1 7 2 3 4 <br /> Number, Stored Product, etc. 87 rJ <br /> TD I-E <br /> Bucket Installation Type: dDire Bury Q Direct Bury Direct Bury ❑Direct Bury <br /> ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump <br /> Bucket Diameter: 12— 1 i <br /> Bucket Depth: 3 1 Z 23 t <br /> E Wait time between applying <br /> PP ymg <br /> vacuum/water and start of test: <br /> Test Start Time(TI): q',30 <br /> Initial Reading(R& U 5/i <br /> Test End Time(TF): 5 O 15 O o 3 G <br /> Final Reading(RF): <br /> Test Duration(TF—Ti): <br /> Change in Reading(RF-Ri): --(!er— �-�— <br /> Pass/Fail Threshold or <br /> Criteria: p <br /> ,:.a. a.a ➢ ti '','tU', w,l ir„ n,blb.Gu�l�i, k•`.'t* 7 T��"�ir��,,,s�f.,r���, t �"`�;s '� �I�� �i�a�� �,CIW�a►1� I s�,l,,,� , ,P�s��� s��l�" WN. ,�.r40..p1 <br /> Comments — (include information on repairs made prior to testing, and recommende ollow-up for failed tests) <br /> Test Water: Taken wit tester Left on site <br /> I hereby certify that all the information contained in this report is true, <br /> accurate, and in full compli ce with legal requirements. Technician: , Zane A. Nil7lrrlo <br /> �f <br /> ICC#: 5263322-UT <br /> Signature: OTTL#: 04-1676 <br />