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Afforda-Te$t 4162nd Street x Dynamic Back Pressure Test <br /> Galt,California 95632 <br /> (209)744-0112 (800)524-9087 FAX <br /> /(209)744-0116 Static Pressure DecayTest <br /> Owner/Contractor/Eng: TESTDATE: ' Vl� X UST (ST30) <br /> I ASTAST (ST38) <br /> SITE NAMJ E: ! P {.O P 1XI"on-plianceTest <br /> PT InitialTest AIR QUALITY AGENCY: <br /> Address: 10, (^.�ftf't ( `A 1 F}J 11 Jin= tiC�L I_S3'U11� (� M <br /> City TECHNICIAN N <br /> - Present Not Present <br /> ( - '�'? �` ! � ~t`� SJV <br /> Phone: ertification# <br /> Contact: TECH SIGNATU : — 0 Z2 y Permit or Facility# <br /> STATIC PRESSURE DECAYTESTDATA Confirmation# <br /> / <br /> #DISPENSERS DISPENSER Make: i ( �A�rc z, NOZZLE Make: PV Valve Make: <br /> # TOTAL NOZZLES Model: Model: A L4 t)-1 Model: <br /> ,IIANIFOLDED: Yes 7 No BALANCE E ASSIST = Assist Type: <br /> Tank 1 Tank 2 Tank 3 Tank 4 TOTAL <br /> Initial pressure before testing- ' /5t'wc <br /> Product Grade � �?1 A/r/ <br /> EQUIPMENT <br /> # Nozzles per Tank t* Decay: Blockage: <br /> 4crunt Tank Capacity ?(-)DD 5 UC,U Z,' 00 Incline Manometer3 Incline Manometer <br /> Gasoline Volume /0, 7 F ? / //26 Magnehelic Gua e 7 Ma nehelic Gua e <br /> �3 �� �y <br /> Ulla a Ca ecin minus Volume) rLf 7, 0-YEquipment Calibration Date: <br /> Phase I Ss stem Tv le: 2 t EVR Coaxial GLV rL <br /> Z tJ <br /> Initial Test Pressure (inches Rater) zio Allowable Fill Time @ <br /> PSI Ir 1 Minute (inches Rater) 2 SUM - <br /> PSI C 2 Minutes z Time 1: <br /> PSI a. 3 Minutes U Time 2: <br /> PSI a a Minutes 7 Time 3: <br /> Final Pressure i� 5 Minutes (inches Nater) i <br /> AlloiNable Final Pressure (CARB) C' <br /> 1 ` Liquid Removal Check, Dynamic Back <br /> Pass / Fail Pass / Fail Pass / Fail Pass / Fail Pas / Fail Pressure (if due), and Parts & <br /> LRepairs Are Listed on Back <br />