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AFFORDA-TE$T Site Name: MANTECA EXPRESS MART <br /> 416 2nd Address:419 S. MAIN ST. <br /> City: MANTECA, CA Zip: 95337 <br /> Facility Permit #: N-1159-1-3 CONF# 15-20467 <br /> Date:5/28/15 Time: <br /> Technician: ZANE NIMMO _ <br /> District Cert #: 0083 Exp. EI� ED <br /> Healy Cert #: 563743702 Exp. 1/5/2017 ' EIV <br /> it(; <br /> ED <br /> Manometer Calibration Date: 4/13/15 JUN 2 6 2015 <br /> HEALY TEST FORM ;N'ViRONMENTAL <br /> J ei <br /> Clean Air Separator Pressure Performance Test Nozzle Bag Test <br /> Fuel Grade: ALL <br /> Nozzle Type: 900 <br /> Initial Vacuum/ Pressure prior to test ❑ - 0 + <br /> #1 PASS #7 #13 #19 #25 #31 <br /> 1. Initial Vacuum / Pressure (W.C.) 2.00 <br /> 2. Vacuum/ Pressure after i minute, inches of water: 2.02 #2 PASS #8 #14 #20 #26 #32 <br /> 3. Vacuum/ Pressure after 2 minutes, inches of water: 2.04 <br /> #3 PASS #9 #15 #21 #27 #33 <br /> 4. Vacuum/ Pressure after 3 minutes, inches of water: 2.06 <br /> 5. Vacuum/ Pressure after 4 minutes, inches of water: 2.08 #4 PASS #10 #16 #22 #28 #34 <br /> 6. Vacuum/ Pressure after 5 minutes, inches of water: 2.10 <br /> #5 #11 #17 #23 #29 #35 <br /> 7. Vacuum/ Pressure after 5 minutes, inches of water: 1.77 <br /> ® PASS ❑ FAIL #6 #12 #18 #24 #30 #36 <br /> 1 declare, under penalty of perjury under the laws of the state of California that based on information and belief formed after reasonable inquiry, the statement. <br /> and information provided in the document are true, accurate, and complete. <br /> Technician Signature: —�`" <br />