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416 2"" Street <br />Galt, CA 95632 <br />(209) 744-0113 Fax (209) 744-0116 <br />E.O. VR -203/204 <br />Vapor Pressure Sensor Verification Test & VST Processor Activation Pressure <br />Test Report Form <br />Permit Number: N-4721-14 <br />CONF # 18-25877 <br />Test Company: AFFORDA TEST <br />416 2ND STREET GALT, CA 95632 <br />209-744-0113 FAX 209-744-0113 <br />Site Name: FOOD <br />MART GAS <br />Technician: Zane A. Nimmo <br />Site Address: 2185 <br />E. FREMONT STREET <br />Certification Number / Expiration Date <br />City: STOCKTON <br />Zip: 95205 <br />District: S J V A P C D <br />Date/Time of Test: <br />9/6/2018 <br />VST: 3000839502 <br />Veeder-Root: Zane A. Nimmo #A28446 <br />TEST INFORMATION <br />Pressure sensor located at dispenser number(s) <br />VENT STACK <br />Pressure sensor serial number <br />1 2 8 06 <br />Calibration date for digital manometer (must be within 12 months of the test) <br />7/13/2018 <br />Ending value for digital manometer drift test (must be 0.01 in. w.c. or less) <br />.00 <br />VAPOR PRESSURE SENSOR UST PRESSURE TEST <br />UST pressure from digital manometer (in. w.c.) <br />3.31 <br />Pressure sensor value from TLS -350 (in. w.c.) <br />3.345 <br />Is Pressure Value Between -0.20 and +0.20 in. w.c.? <br />YES <br />VAPOR PRESSURE SENSOR AMBIENT REFERENCE TEST1,2 <br />Non -calibrated pressure sensor value from TLS -350 (in. w.c.) 0.037 <br />Is pressure value between -0.20 and +0.20 in. w.c.? YES <br />VST PROCESSOR ACTIVATION PRESSURE TESTf,a <br />VST processor activation pressure (in. w.c.) <br />Is the VST processor activation pressure _< 0.4 in. w.c.? N / A <br />NOTES: 'Valve must be returned to normal operating position after testing is comp>ietea. <br />ZThe ambient reference port cap must be in place after testing is completed. <br />I declare, under penalty <br />of perjury under the laws of the state of California that based on information and belief formed <br />after reasonable inquiry, the statements and information provided in this document are true, accurate, and complete. <br />Signature of Technician: ej Date: 9/6/2018 <br />