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Y � <br /> Afforda-Te$t Spill Bucket <br /> 416 2nd Street 209 744-0112 Test Report <br /> Galt, Ca. 95632 FAX 209 744-0116 1, <br /> I. FACILITY INFORMATION <br /> Facility Name: �1� L AQ ICSYYp Date of Testing: 2a <br /> Facility Address: a <br /> Facility Contact: Phone: 2.0,1 9 g 2 Uel <br /> Date Local Agency Was No fied of Testing <br /> Name of Local Agency Inspector(ifpresent during testing): <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: <br /> Technician Conducting Test: N b <br /> Credentialsl: ❑CSLB Contractor ICC Service Tech. SWRCB Tank Tester ❑Other(Specify) <br /> License Number(s): <br /> 3. . SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: Hydrostatic ❑ Vacuum ❑Other <br /> Test Equipment Used: O Equipment Resolution: <br /> Identify Spill Bucket(By Tank 12 3 4 <br /> Number, Stored Product, etc. �7 q I b I C <br /> Bucket Installation Type: Direct Bury Direct Bury Duect Bury ❑Direct Bury <br /> ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump ❑Contained in Sum <br /> Bucket Diameter: I I I I ( <br /> Bucket Depth: 14 IA— r q <br /> Wait time between applying <br /> vacuum/water and start of test: <br /> Test Start Time(TI): 9 <br /> Initial Reading(Rt): I <br /> Test End Time(TF): b Lo I o I S 3 <br /> Final Reading(RF): I D I <br /> Test Duration(TF—Ti): <br /> Change in Reading(RF-Rj): —ty— <br /> Pass/Fail Threshold or <br /> Criteria: <br /> ,,e <br /> Comments—(include information on repairs made prior o testing, and recommen ed flow-up for failed tests) <br /> ll- N _� <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 Date: (e ZO <br />