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416 2nd <br /> t CA <br /> 32 <br /> AFFORDA-TE$T (209 744-0112 ret 2 9x'744 0 16 Fax Spill Bucket <br /> � � ) Test Report <br /> TEST DATE L} <br /> I� <br /> SITE NAME � ' f/l (/I !E J%i ! / PHONE ( <br /> ADDRESS CONTACT: <br /> 1. �j- <br /> bf2 <br /> (' I tJ I/ <br /> Inspector: Present / Not Present <br /> 3. SPILL.BUCKET TESTING INFORMATION <br /> Test Method Used: Hydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used: 4 010 Equipment Resolution: <br /> Identify Spill Bucket(By Tank 1 2 3 4 <br /> Number, Stored Product, el,{k-- <br /> ' ❑Direct Bury ❑Direct Bury ❑Direct Bury ❑Direct B <br /> Bucket Installation Type: m'Y <br /> Contained in Su '.Contained in Sump ❑Contained in Sump ❑Contained in Sum <br /> t Bucket Diameter: Z <br /> Bucket Depth: ) <br /> Wait time between applying <br /> T <br /> vacuum/water and start of test: — <br /> Test Start Time(Ti): <br /> Initial Reading(Ri): <br /> Test End Time(TF): <br /> Final Reading(RF): 3 f y n 31q <br /> Test Duration(TF–TI): O v rx1 <br /> Change in Reading(RF-RI): <br /> Pass/Fail Threshold or <br /> Criteria: <br /> Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> Test Water: Taken with tester Left on site <br /> I hereby certify that all the information contained in this report is true, <br /> accurate, and in full compliance J with legal requirements. Technician: Lyle D. Nimmo) ICC#: 5249115-UT <br /> Signature: 1';a x ' ,/�jr;�l �e OTTL#: 97-114.3 <br /> - - <br /> U <br />