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AFFORDA-TE$-p 416 2nd <br /> 209 744®'i12t 2 Gait CA <br /> 95 FAx Spill Bucket <br /> ( ) ( ) Test Report <br /> TEST DATE — <br /> SITE NAME �Y1�� - �G�Y ��f PHONE <br /> ADDRESS ,�� '� `:1 d r,,t° - �.. �1'C1 CONTACT: �C,G'� <br /> Inspector: j f 1�(,'�,,1)'S,t� �-� Prese t / Not Present <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ,,Hydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used: , �' 7, Equipment Resolution: �2 <br /> i <br /> Identify Spill Bucket(By Tank 1 �/ 2 3 4 <br /> Number, Stored Product, etc. 1S <br /> E: t <br /> Bucket Installation Type: .aDirect Bury Direct Bury R Direct Bury aDirect Bury <br /> ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump <br /> Bucket Diameter: <br /> Bucket Depth: \C11 <br /> I 11 <br /> Wait time between applying �- <br /> vacuum/water and start of test: <br /> Test Start Time(Ti): <br /> Initial Reading(RI): 3/ L <br /> Test End Time(TF): 007 <br /> Final Reading(RF): <br /> Test Duration(TF—T!): C OV <br /> Change in Reading(RF-RI): <br /> Pass/Fail Threshold or <br /> Criteria: <br /> ✓,�01� <br /> n"''j - 5 ❑F <br /> *, <br /> Comments — (include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> Test Water: ©Taken with tester Left on site <br /> I hereby certify that all the information contained in this report is true, <br /> accurate, and in full comp iance with legal requirements. Technician: Lyle D. Nimmo <br /> ICC #: 5249115-UT <br /> Signature: {� ��. OTTL#: 97-1143 <br />