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a <br /> FORA®T 1 416 2nd Street Galt Cao 95632 Spill Bucket <br /> I� (209) 744-0112 (209) 744-0116 FAX -rest Report <br /> 1. <br /> TEST DATE "Oj � � <br /> SITE NAME C -�9eGeC� /�� 9r�6ir'1C: PHONE ( 209 )_3�s' l L 7-9 <br /> ADDRESS ejOO S. C,1-jfc�r;tC_E� LA CONTACT: 1 <br /> Inspector: I)AeZU *t� +J -FOt,�I>,- <br /> Present Not Present <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: Hydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used: —1--ci if .Z Equipment Resolution: i <br /> Identify Spill Bucket(By Tank 1 2 3 4 <br /> Number, Stored Product, etc. 69 9 1 p Fj G <br /> Bucket Installation Type: Direct Bury Direct Bury ADirect Bury Apirect Bury <br /> ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump ❑Contained in Sum <br /> Bucket Diameter: 111 11 11 1 �L <br /> Bucket Depth: I`f <br /> Wait time between applying <br /> vacuum/water and start of test: <br /> Test Start Time(TI): e5 2J6 G <br /> Initial Reading(RI): 0 q1 ,2-- 1 C> I r4s C 1 <br /> Test End Time(TF): '2— C1q .75 9 3 G <br /> Final Reading(RF): 3 , �y i z 674 <br /> Test Duration(TF—TI): I-i OL <br /> Change in Reading(RF-Rl): - —" }- - -� <br /> Pass/Fail Threshold or <br /> Criteria: <br /> _J. ' 8A 8 w 8111 E <br /> Comments—(include informati n n repairs made prior t t sting, and recommended o11ow-up for failed 4U <br /> Test Water: waken with tester F�Left on site <br /> I hereby certify that all the information contained in this report is true, <br /> accurate, and in full compliance with legal requirements. Technician: , Zane A. Nimmo <br /> _ —-- ICC#: 5263322-UT <br /> OTTL#: 04-1676 <br /> Signature "w ---- ---- <br /> _ _ <br />