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411 2nd <br /> AFF®RDA-TET (20 ) 744-0112 Street <br /> 2Gait C 0196 FAX Spall Bucket <br /> t ) Test Report <br /> TEST DATE S �� <br /> SITE NAME a^//T� q',f PHONE <br /> ADDRESS yV6 W. e 40e-TFC WA—,v CONTACT: <br /> o C To 'od 6 <br /> Inspector: P� V .�oE1 A) Present Not Present <br /> 3. SPILL BUCKET <br /> TESTING INFORMATION <br /> Test Method Used: XHydrostatig ❑Vacuum ❑Other <br /> Test Equipment Used: Equipment Resolution: t <br /> Identify Spill Bucket(By Ta1 Q 2 qI l 1 3 4 <br /> Number, Stared Product, etc.) J <br /> irect Bury Direct Bury ❑Direct Bury ❑Direct Bury <br /> Bucket Installation Type: ❑Contained to Sum D Contained in Sum ❑Contained in Su ❑Contained in Sum <br /> Bucket Diameter: 1 i — t 1 — <br /> Bucket Depth: 13 '/If (3 <br /> Wait time between applying <br /> vacuum/water and start of test: <br /> Test Start Time(TI): 9 So 'IS d <br /> Initial Reading(RI): i -- 1 1 , <br /> Test End Time(TF): l o SO t9 0 Sa <br /> Final Reading(RF): it — It — / <br /> Test Duration(TF—TI): u� <br /> Change in Reading(RF-Ri): �- <br /> Pass/Fail Threshold or <br /> Criteria: <br /> ,...�,v <br /> ✓ � 1� m n Nx <br /> �,Ca,;.{,a1�.a., g .v', •i.. r,ba a�k�°d4,vfn � c,� „1�,.'4��5.1 SiNt'lS;.di��'a��:�'11�fa tih �.S �. 1 x ��1, u l �,a,4 ��� i`,���.8i �� a�,1��u � �� �,sa�6 .<� all" �t <br /> Comments— (include inforniatiA on repairs inade prior to testing, and recommended follow-up far-failed tests) <br /> Test Water: Taken with tester Lefton 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. Nlmmo <br /> �- -- ICC#: 5263322-UT <br /> Signature --- ----- OTTL#: 04-1676 <br />