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AFFORIUA-TE$T Site Name: MANTECA EXPRESS <br /> 416 2nd Street Address.419 S MAIN ST <br /> + City: MANTECA CA Zip: <br /> Galt, CA 95632 <br /> (209) 744-0112 Fax (209) 744-0116 Facility Permit #: N 1159 <br /> Date:5-14-13 Time: it <br /> Technician: DAVE WINKLER <br /> District Cert #: 0082 Exp. <br /> Healy Cert #: 00516633702 1 Exp. 12-27-14 +_ <br /> c. . <br /> Digital Manometer Calibration Date: 5-1-13 <br /> H EALY TEST FORM <br /> Clean Air Separator Pressure Performance TeNozzle Baa Test <br /> -Fuel Grade: ALL <br /> Nozzle Type: HEALY 900 <br /> Initial Vacuum/Pressure prior to test - ❑ + <br /> . In a acuum Pressure 2.0 <br /> 3.Vacuum/Pressure after 2 minutes, inches of v�ater: 2.02 <br /> #3 #9 #15 #21 #27 #33 <br /> 4.Vacuum/Pressure after 3 minutes, inches of Water: 2.04 1. <br /> #10 #16 1l #22 #28 #34 <br /> 5.Vacuum/Pressure after 4 minutes, inches of v Ater:`2.04 #4 I <br /> 6.Vacuum/Pressure after 5 minutes, inches of vi ter: 2.06 #5 #11 #17 ( #23 #29 #35 <br /> M -.80 <br /> Zowable final vacuum: <br /> < M #6 #12 #18 #24 #30 #'6 <br /> M. P4SS FAIL <br /> m � <br /> Me , clare, under penalty of perjury under thi,laws of the state of califomia that based on information and belief formed after reasonable inquiry, the statement. <br /> j dn�l information provided in the document are true, accurate, and complete. <br /> ti f <br /> Z r- o <br /> F ahniclan Signature: <br />