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CONTRACTOR/ENGINEER <br />ORDERING TEST <br />POB 36 26515 N. SACTO. BL. I LINE & LEAK DETECTOR <br />THORNTON, CA. 95686 TEST REPORT <br />(209)794-0102 (800)524-9087 <br />TEST DATE /— f — C? <br />SITE: <br />OPERATORIW `� !' r? (? Station# <br />OWNER <br />SITE ADDRESS / �/ �-f ~�� <br />LINNS) ONLY <br />x / y r' <br />ADDRESS <br />LINF(s)-LEAK DET. <br />TANK(s)-LINE(s)-LEAK DET. <br />PHONEry:CC? <br />COVEROVER " JJ <br />LINES—Id Vl Q h 7 `P <br />--zaW �f - r, :7 •, ..,; <br />PHONE ' <br />REASON FOR TEST I <br />LOCATION SKETCH <br />,,IOW S ITLE El S BLDU.S, TANKS ISLANDS' PIPING F KNOWN PUMPS OR DISPENSERS <br />LINNS) ONLY <br />` 7751rLINE(s <br />LINF(s)-LEAK DET. <br />TANK(s)-LINE(s)-LEAK DET. <br />MAKE R TYPE OF PUMP <br />OR.DMPENSER <br />COVEROVER " JJ <br />LINES—Id Vl Q h 7 `P <br />APPROX BURIAL, <br />DEPTH / (/ <br />WFAMER <br />PRESSURE <br />X <br />SUCTION <br />LEAK DETECTOR <br />FTA LEAK DETECTOR TEST INFORMATION Calibrate <br />10 PSI <br />E <br />y <br />TYPES: <br />No. <br />LD <br />Serial <br />Number <br />Resiliency <br />Oppening <br />Tlme <br />In Seconds <br />Test <br />Leak Rate <br />M in <br />FunctionalM1lderutg <br />Element <br />Holdin PSI <br />PSI <br />Yes / <br />No <br />Product <br />XLD P/N 116036-5 <br />BFLD (XL MODEL) <br />PIN 116039-5 <br />PLD PM 116030-5 <br />XLP P/N 116033-5 <br />DLD P/N116017-5 <br />BFLD P/N 116012-5 <br />OTHER <br />Notes <br />CONTRACTOR <br />CERTIFICATION <br />LINE TEST RESULTS <br />TESTIS If ERE AIADE ON THE LINE SYSMUSAS NOTED JNACCORDANCF. WITH TEST <br />PROCEDURES PRESCRIBED FOR AS DETAILED ON THE TEST CHART ON SIDE 1 <br />OF7711SFORM 1IT171RESULTSASFVLLOn. <br />TECHMCIAN:, YLED. NIMMO <br />s1ar+ATUlteLINE <br />IDENTIFICATION _ —1 NET VOLUME C ANGE PER HOUR <br />PETROME CERT. # 090993AO163 <br />OITL GIC N 'A-1143 <br />TrwmNwa <br />5 J <br />PASS)/ FAIL / INCONCLUSIVE <br />PASS J FAIL / INCONCLUSIVE <br />Trim S <br />LSI <br />i PASS' / FAIL / INCONCLUSIVE <br />FEATURING PETR TITS UNE TESTER <br />I PASS. / _FAIL / INCONCLUSIVE <br />