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AFFORDA-TE$T 416 2nd Street Galt CA 95632 LIME & LEAK DETECTOR <br /> (209) 744-0112 FAX (209) 744-011b TEST REPORT <br /> CONTRACTOR/ENGINEER TEST DATE <br /> M <br /> SITE NAME i�j'✓') �OfL <br /> PHONE <br /> ADDRESS ` C��� ��} �y�� /,� 4r <br /> Repair/Construction LOCATION SKETC / Show North <br /> Compliance bd–rTv nl� <br /> Insurance <br /> Escrow rj , <br /> Make &Type of Pump or Dispenser <br /> Cover Over Lines <br /> Approx Burial Depth riy Det <br /> Weather <br /> Pressure SUctlOrl SHOW STREETS, BLDGS,TANKS, ISLANDS, PII`TNG(IF KNOWN), PUMPS OR DISPENSERS <br /> LEAK DETECTOR FTA LEAK DETECTOR TEST INFORMATION Calibrate <br /> 10 PSI <br /> Opening I Element <br /> LD Serial Time In Test Leak Holding Pass/ <br /> KEY TYPES No/Product Key Number Resiliency Seconds Rate ML/Min PSI Metering PSI Fail <br /> A LD 2000 tre 7 <br /> B LD 2000 E <br /> C FXI V , [ I ?Y ) Ai ZG i 2– (� <br /> D FXI DV <br /> E STPMLD e�l1q UPJ. `j i `i 3 I Z 15 <br /> F STPMLD - D <br /> G STPMLD - E 91109 A-3 Z_s I prr-:6 <br /> H STPMLD - D/E Notes: <br /> CONTRACTOR LINE TEST RESULTS <br /> CERTIFICATION Tests were made on the line systems as noted in accordance with test procedures <br /> f <br /> Technician: ane,A. 171171 <br /> N10 prescribed for as detailed on the test chart on Side 2 of this form with results as follows: <br /> � � <br /> LINE IDENTIFICATION NET VOLUME CHANGE PER HOUR <br /> PETROTITE CERT#, Di E-"L PASS /FAIL / INCONCLUSIVE <br /> CCA0202112304R <br /> OTTL Lic#04 1676 i—gC7- K PASS % FAIL / INCONCLUSIVE "' 0 b <br /> Trainee:%�6 iX �i� �",,– PAS' FAIL / INCONCLUSIVE U <br /> I ;r-r PASS / FAIL / INCONCLUSIVE f c) <br /> EQUIPMENT:PETRO TITE LINE TESTER <br />