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Afford.-Telt Spill Bucket <br /> 416 2nd Street 209 744-0112 Test Report <br /> Galt, Ca. 95632 FAX 209 744-0116 p <br /> I. FACILITY INFORMATION <br /> Facility Name: J '� L M A�ICJEDate of Testing: 2p O G <br /> Facility Address: CA <br /> Facility Contact: Phone: ��� g Ug 6 <br /> Date Local Agency Was No feed of Testing : I 1 <br /> Name of Local Agency Inspector(f present during testing): <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: <br /> Technician nducting Test: N b <br /> Credentials l:Co, Contractor ICC Service Tech. TRC Tank Tester ❑Other(Specify) <br /> License Number(s}: <br /> 3. . SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: H drostatic ❑Vacuum ❑Other <br /> Test Equipment Used: j�,P E _O Equipment Resolution: <br /> Identify Spill Bucket(By Tank1 2 3 4 <br /> q ' <br /> Number, Stored Product, etc. �7 I <br /> Bucket Installation Type: Direct Bury Direct Bury Direct Bury ❑Direct Bury <br /> ❑Contained in Sump ❑Contained in Sump ElContained in Sump ❑Contained in Sum <br /> Bucket Diameter: � � I � ' <br /> Bucket Depth: (e+ I - ? r <br /> Wait time between applying <br /> vacuum/water and start of test: <br /> Test Start Time(Tj): y p 7 S 3 <br /> Initial Reading(R,): p V I Z <br /> Test End Time(TF): b Zo v l g 3 <br /> Final Reading(RF): <br /> Test Duration(TF—Tj): (� <br /> Change in Reading(RF-RI): --v — � <br /> Pass/Fail Threshold or <br /> Criteria: <br /> :}. <br /> T05t�R .SFU I, ? "" P�•"'� yJ,a'"., k ,..>a"+( p--�; eta�.tgti i4.: 5 ''�`f .- a tl k' aril fe':,,i 't ,k 'r. o':�-r <br /> �Pass,� 11Fa�l' j` , a` <br /> Comments —(include information on repairs made prior to testing, and recommen ed)bllow-up for failed tests) <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereby certify that all the information contained in this report is true, accurate,and in full compliance with legal requirements. <br /> Technician's Signatur <br /> Date: �e 10 c� <br />