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Afforda-Te$t Spill Bucket <br /> 416 2nd Street 209 744-0112 Test Report <br /> Galt, Ca. 95632 FAX 209 744-0116 p <br /> 1. FACILITY INFORMATION <br /> Facility Name: fA Date of Testing: i <br /> Facility Address: O A, RVf- `l:Ab . - G O,,I(?f e +a- 0-7 <br /> Facility Contact: 1Y af� Phone: 1,�5 ' -y a jo <br /> Date Local Agency Was Notified of Testing :cj <br /> Name of Local Agency Inspector(if present during testing): ; <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: ' <br /> Technician Conducting Test: ZIMMO <br /> Credentials: ❑CSLB Contractor ❑ICC Service Tech. bQ SWRCB Tank Tester ❑Other(Specify) <br /> License Number(s): (j I (, <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: 'Hydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used: T pv,�)e— 1 0 Equipment Resolution: ! �, <br /> Identify Spill Bucket(By Tank 1 A) 2 - 3 t 4 <br /> Number, Stored Product, etc. <br /> Bucket Installation Type: "irect Bury ,�Direct Bury Pf Direct Bury ❑Direct Bury <br /> ❑Contained in Sump ❑Contained in Sum ❑Contained in Sump ❑Contained in Sum <br /> Bucket Diameter: <br /> Bucket Depth: <br /> Wait time between applying <br /> vacuum/water and start of test: <br /> Test Start Time(TI): 130 3 Q D <br /> Initial Reading(RI): V-0 ' /y <br /> Test End Time(TF): ,�o 2 ;o <br /> Final Reading(RF): /v 1 Iq <br /> Test Duration(TF—.T,): h \)r o ✓ 61"Ar <br /> Change in Reading(RF-RI): IQ - <br /> Pass/Fail Threshold or <br /> Criteria: <br /> Tis = 2 t�° r as a ' bass pail Pass'���Fail .0 Pass ❑Fail , <br /> Comments—(include information on repairs"made prior to testing, and recommended follow-up for failed tests) <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereby certify that all the in rm on ntained in this report is true,accurate,and in full compliance wit legal r quirements. <br /> Technician's Signature. - Date: 1 Com✓ <br />