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�00+� 1 UST 0 <br /> g7l f,W <br /> 'CCa AMLRM'RMCO. [ICGICl' <br /> TP-201 . 101) <br /> Leak Rate of Drop Tube/Drain Valve Assembly and Leak Rate of Drop Tube Overfill Protection Devices and Spill <br /> Container Drain Valves Report Form <br /> Permit Number: Test Company : Confidence UST Services, Inc. <br /> Confirmation : Technician : Timothy Capehart <br /> Site Name : 99 Shell Certification Number Expiration Date <br /> Site Address : 1687 Highway 99 District: SJV-0312 9/30/20 <br /> City/Zip: Stockton 95212 Franklin (Healy) : 1011103708 08/17/2020 <br /> Date/Time of Test : 4/11 /2019 at 11 :00 pm Veeder-Root: 647819 10/05/2020 <br /> DROP TUBE DRAIN VALVE AND OVERFILL PROTECTION DEVICE PRESSURE INTEGRITY TEST <br /> ❑ Straight Drop Tube1 0 Drop Tube with an Overfill Protection Device' <br /> Pressure measuring device 0 digital manometer ❑ mechanical aauge <br /> Calibration date for pressure measuring device (must be within 180 days of the test) 01 /20/2019 <br /> Ending value dor digital manometer drift test if applicable (must be 0. 01 in. w. c. or less) 0 . 00" <br /> Drop Tube Drain Valve Pressure Test: Drop Tube Overfill Device Pressure Test " Corrected " Overfill Device Leak Rate <br /> Flow rate 80 ml/min Flow rate 200 ml/min <br /> Minus Equals <br /> Time to reach 2 in. Drain valve Final Time to reach 2 in. Overfill Final Overfill Device Drain Valve Corrected <br /> w.c. at 80 ml/min. leak rate Pressure w. c. at 200 ml/min. leak ratepressure Leak Rate Leak Rate Leak Rate <br /> Tank Grade sec, ml/min in. w. c. mins. ml/min. in. w. c, ml/min. ml/min. ml/min. <br /> 1 Regular 2 . 58 mins 10 MIS 2002" <br /> 2 Super 2. 62 mins 20 mis 2. 00" <br /> 3 <br /> 4 <br /> NOTES : lA straight drop tube must be tested with a bladder in place and using a flow rate of 80 ml/min. M <br /> Z <br /> ZThe bladder section of TP-201 . 11) may be skipped if the entire drop tube passes with a leak rate below 80 ml/min. < <br /> 3Leak Rate = nitrogen flow rate needed to maintain a constant pressure (at least 2 in. w. c.) for 30 seconds. 0 <br /> I declare, under penalty of perjury under the laws of the state of California that based on information and belief formed after reasonable inquiry , the D <br /> statements and information provided in this document are true, accurate, and complete. Z <br /> Z <br /> Signature of Technician : Date: 4/11 /2019 1-- Cn <br /> � m <br /> M 0M <br />