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f' � 416 2nd Street Galt C,4 35632 p i�� B�.���'�`� ' <br /> �_ �� � � (209) 744-0112 (209) 744-0116 FAX Test <br /> Repork <br /> TEST DATE <br /> SITE NAME O7� t'. ; / I �!` H l .,1 't°cX `+'` �tt ! /`/Cj PHONE <br /> ADDRESS "� �4 N� I c X CONTACT: T3 N <br /> Inspector: r Present Not Present <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: [).Hydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used: ,�� Equipment Resolution: <br /> Identify Spill Bucket(By Tank 1 2 3 4 <br /> Number, Stored Product, etc) <br /> Bucket Installation Type: ❑Direct Bury ❑Direct Bury ❑Direct Bury ❑Direct Bury <br /> )jrContained in Sump AContained in Sump ❑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): '�g` Qg '`/07— <br /> Initial Reading(Ri): <br /> Test End Time(TF): S� <br /> Final Reading(RF): � f <br /> Test Duration(TF—Tj): <br /> Change in Reading(RF-Rj): <br /> Pass/Fail Threshold or <br /> Criteria: <br /> �,�Y{E .,: r r.w �M .4, • 4 .a{k.f .,,_wry i...�.�;}L ��� `�. ��.�MIT <br /> . <br /> ID i N1Wr <br /> YC r P C7 FalldS G <br /> �7{eS�MEN <br /> ]� a .»rina�d�l u <br /> #...,;Ia;� ,,.�., .#s•.m' r � €�. <br /> Comments- (include information a airs made prio tes . g, and recommended follow-up for failed tests) <br /> Test Water: Taken 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: Lyle D. Nimmo <br /> -0 /� i)Q� ICC#: 5249115-UT <br /> Signature: i :,/a OTTL#: 97-1143 <br />