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&g416Te t 2"d Street Phone: (209) 744-0112 LINE & LEAK DETECTOR <br /> Galt, Ca 95632 Fax: (209) 7444116 TEST REPORT <br /> afforda@softcom.net <br /> CONTRACTOR/ ENGINEER TEST DATE 2/28/2019 <br /> SITE : DAMERON HOSPITAL <br /> 525 W . ACACIA STREET <br /> STOCKTON, CA 95203 <br /> Repair/Construction LOCATION SKETCH Show North <br /> ® Compliance ® Owners Request <br /> ® Insurance ❑ Escrow SHOW STREETS , BLDGS , TANKS , ISLANDS , PIPING ( IF KNOWN ), PUMPS OR DISPENSERS <br /> ® Other In Lue of Shutdown <br /> Make & Type of Pump or Dispenser <br /> RED JACKET <br /> Cover Over Lines <br /> CONCRETE <br /> Approx Burial Depth <br /> 2 - 3 FEET <br /> Weather <br /> COLD OVERCAST <br /> Pressure ® Suction <br /> Calibrate <br /> LEAK DETECTOR FTA LEAK DETECTOR TEST INFORMATION to PSI <br /> Opening Test Leak I Element <br /> KEY TYPES No/ LD Serial Resiliency Time In Rate Holding Metering Pass/ <br /> Product Key Number Seconds MUMin. PSI PSI Fail <br /> A LD 2000 <br /> B LD 2000 E R. DIE B 50 5 189/ 1 26 17 PASS <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 <br /> CERTIFICATION LINE TEST RESULTS <br /> Technician : Tests were made on the line systems as noted in accordance with test procedures <br /> Zane A.Nimmo 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 /> OTTL License #: 044676 <br /> PETROTITE CERT. [] PASS ❑ FAIL ❑INCONCLUSIVE <br /> # :CCA0202112304R RED DIESEL - . 0030 <br /> ICC# 5263322 UT ®PASS ❑ FAIL ❑ INCONCLUSIVE <br /> Trainee: CHRIS MONTERO ❑PASS ❑FAIL ❑ INCONCLUSIVE <br /> ❑PASS ❑FAIL ❑ INCONCLUSIVE <br /> EQUIPMENT: PETRO TITE LINE ❑ PASS ❑FAIL ❑ INCONCLUSIVE <br /> TESTER <br /> Notes : <br />