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AFF®R®A-TE T 416 2nd Street Galt CA 95632 Spell BLIcket <br /> (209) 744-0112 (209) 744-0116 FAX -rest Report <br /> TEST DATE a <br /> SITE NAME J PHONE ( ,-20`� <br /> ADDRESS g( ( S S . t_ D02D. o S CONTACT: <br /> ekKy-g <br /> Inspector: }� P� D USN resent / Not Present <br /> 3. SPILL BUCKET TESTLNG INFORIIIATION <br /> Test Method Used: OtHydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used: Equipment Resolution: t ( 6 .. <br /> Identify Spill BucketL(Byank 1 2 3 4 <br /> Number, StoredProdtc. / <br /> Bucket Installation Type: Direct Bury irect Bury ADirect Bury ❑Direct Bury <br /> ❑Contained in Sump ❑ Contained in Sump ElContained in Sump ❑Contained in Sum <br /> Bucket Diameter: i <br /> Bucket Depth: 14 <br /> Wait time between applying <br /> vacuum/water and start of test: <br /> Test Start Time(TI): 1 3� 1300 00 <br /> Initial Reading(Ri): p 3 <br /> o — <br /> Test End Time(TF): oO 14 ap <br /> Final Reading(RF): I �4y ( 0 — <br /> Test Duration(TF—Ti): o e— lZ <br /> Change in Reading(RF-Rj): �— <br /> Pass/Fail Threshold or <br /> Criteria: <br /> �7 nWy Idi.•i' 1 K'. HH'i' IkUI '" L' d' 1 F �,y Att1 t1t, W. �p', <br /> �} <br /> hkt� a Y9 }n Rid 911 inr uan <br /> J n I r <br /> u -, l;a�� '',� "t..� .��...,inem51?,x,+n�:,. e i 5�1+� s�a[i1.�+: .G�`.+#.. Y��S''FC•7§N�- .1'dl�a4�1�F�x�,�,�a5S�Y4t���FR111�f�:.11 <br /> Comments — (include information on repairs made prior to testing, and recommended follow-tip for failed tests) <br /> Test Water: Taken with tester QLeft on site <br /> I hereby certify that all the information contained in this report is true, <br /> accurate, and i fup' Incewi legal requirements. Technician: , Zane A. Nimmo <br /> <-- ICC#: 5263322-UT <br /> Signature: - OTTL#: 04-1676 <br />