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AFFORDA-TE$T 416 2nd %treet Galt CA 95632 LINE & LEAK DETECTOR <br /> X209) 744-0112 FAX (209) 744-0116 TEST REPORT <br /> CONTRACTOR/ENGINEER TEST DATE d _,. / —/) <br /> SITE NAME <br /> 6-1 PHONE <br /> J >-' <br /> ADDRESS <br /> Repair/Construction LOCATION SKETCH Show North <br /> Compliance <br /> Insurance <br /> Escrow <br /> Make&Type of Pump or Dispenser <br /> to `i ✓t <br /> Cover Over Lines <br /> /1 <br /> Approx Burial Depth <br /> Weather <br /> Pressure Suction ISHOW STREETS, BLDGS,TANKS, ISLANDS, PIPING(IF KNOWN), PUMPS OR DISPENSERS <br /> LEAK DETECTOR FTA LEAK DETECTOR TEST INFORMATION calibrate <br /> 10 PSI <br /> Opening I Element <br /> LD Serial Time In Test Leak Holding Pass/ <br /> KEY TYPES No/Product Key Number Resiliency Seconds Rate ML/Min PSI Metering PSI Fail <br /> A LD 2000 A)IP, <br /> B LD 2000 E <br /> C FXI V <br /> D FXI DV <br /> E STPMLD <br /> F STPMLD - D <br /> G STPMLD - E <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. N1mmo 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 /> PETROTITE CERT# �.� r ".:" ✓ ! PASS / FAIL / INCONCLUSIVE <br /> 090993AO163 OTTL <br /> Lic#97-1143 PASS / FAIL / INCONCLUSIVE <br /> Trainee: PASS / FAIL / INCONCLUSIVE <br /> PASS / FAIL / INCONCLUSIVE <br /> ")UIPMENT.PETRO TITE LINE TESTER <br />