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CONTR.ACTOMNGINI:ER <br />ORDERING TEST <br />AFFORDA-TEST 12097940112 P.0e <br />y POD 36 26515 N. SACTO, BL, LINE & LEAF( DETECTOR <br />THORNTON, CA. 95686 TEST REPORT <br />(209)794-0102 (800)524-9087 <br />TEST DATE /– y''� – 0 3 <br />SITE: <br />OPERATOR A11* l er y� y � �i �` t t � s � Station# <br />OWNER <br />SITE ADDRESS ;LJV �a! ! t , <br />ADDRESS lT Y^ <br />ANK(s}-LD4Qs <br />114E(s)-LLAIC DLT. <br />PHONE { G L�%� ' - "? �� v �? �� <br />PHONE <br />REASON FOR TEST <br />LOCATION SKETUT <br />S110w SfREMS BLOdS TANKS ISLANf7 � PIPiNO f KNOWN NJMPS OR DiSPENSEAS __ <br />n <br />I'm <br />s w <br />LINE(s) ONLY <br />ANK(s}-LD4Qs <br />114E(s)-LLAIC DLT. <br />TANK(s)-1I4R8)-LEAK DET. <br />MAKE * TYPE OF PUMP <br />ORMWENSER 0�C q H <br />COVER OVER <br />LM -3 �C�Y1ar��� <br />AFFIMK SMAL n I/ <br />DEPTH (/ <br />WP.ATHiER <br />Plil?SSt1itl? <br />M <br />SUCTION <br />Lj <br />AK DETECTOR <br />LE <br />FTA LEAK DETECTOR TEST INFORMATION <br />m <br />Calibrate ; . <br />10 PSI <br />%�'ES' <br />No, <br />LD <br />Serial <br />Re-tillency <br />in <br />lure <br />In SecundaHoldin <br />Test <br />leak Bate <br />un aft <br />Element <br />Mf <br />td <br />PSI <br />g <br />Yes / <br />No <br />KEYNumber <br />Pr�dHd <br />XLD P/N 1160365 <br />_I <br />ILD PIN 116030-5 <br />XLP P/N 116035-5 <br />— <br />$ <br />DLD P/N116017-5 <br />BFLD PM 116012-5 <br />-- <br />J <br />OTnLR <br />j <br />— <br />es <br />Notes <br />CONTRACTOR <br />LINE TEST RESULTS <br />STY AV&MADE ON 7NEUNE SYUMSAS NOTED DV ACCOPJ DANCE <br />FRCEDURaPRECRBEDFOR ASDBTNLEt)ONrHEM,TCHRONSDE2 <br />OF77IISFt9RMfvM1RFSULT3ASFUL.OW: <br />WTM ? ES <br />ICERTIIICATION <br />to <br />T£CHmcim XIEDNIMMO <br />(tt <br />LINE IDIMFICANET UME PtGE PER LfO(U <br />r <br />PETROME CERT. # 090943A0163 <br />OtTt, LIC AI 11.1143 <br />T)vi eNaw <br />S <br />;PASS)/ FAIL / INCONCLUSIVE00 <br />PASS / FAIL / INCONCLUSIVE <br />�- <br />'PASS) / FAIL / INCONCLUSIVE <br />–__ - t <br />DU *�5 .�5— <br />F'EATVFIN0PaR PFE <br />WULUjIR <br />PASS / FAIL / INCONCLUSIVE <br />-- <br />