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fforda Tet 416 2"d Street Phone : (209) 744-0112 LINE & LEAK DETECTOR <br /> Galt, Ca 95632 Fax : (209) 744-0116 TEST REPORT <br /> affords@softeom . net <br /> CONTRACTOR/ENGINEER TEST DATE 02 / 07 / 2020 <br /> SITE NAME DAMERON HOSPITAL PHONE (209 ) 944 - 5550 <br /> SITE ADDRESS 525 ACACIA AVE STOCKTON CALIFORNIA CITY STOCKTON CA 95203 <br /> Repair/Construction LOCATION SKETCH Show North <br /> ® Compliance <br /> Insurance , <br /> EscrowEr <br /> � � <br /> Make & Type of Pump or Dispenser <br /> RED JACKET <br /> Cover Over Lines <br /> CONCRETE ENVIRONMENTAL ' ' `� <br /> ► IIeALI <br /> DEPART T \LENT <br /> Approx Burial Depth <br /> 36' <br /> Weather <br /> SUNNY <br /> ® Pressure Suction SHOW STREETS , BLDGS , TANKS , ISLANDS , PIPING ( IF KNOWN ) , PUMPS OR DISPENSERS <br /> Calibrate <br /> LEAK DETECTOR FTA LEAK DETECTOR TEST INFORMATION 10 PSI <br /> Opening Test Leak I Element <br /> KEY TYPES No/ LD Serial Resiliency Time In Rate Holding Metering Pass/ <br /> Product Key Number Seconds ML/Min . PSI PSI Fail <br /> A LD 2000 <br /> B LD 2000 E <br /> C FXI V <br /> D FXI DV <br /> E STPMLD <br /> F STPMLD - D <br /> G STPMLD - E <br /> H STPMLD—D/E Notes : <br /> CONTRACTOR LINE TEST RESULTS <br /> CERTIFICATION <br /> Technician : Tests were made on the line systems as noted in accordance with test procedures <br /> prescribed for as detailed on the test chart on Side 2 of this form with results as follows: <br /> FELIX RAMIREZ LINE IDENTIFICATION NET VOLUME CHANGE PER HOUR <br /> o <br /> PETROTITE CERT. # : RED DIE PASS - 00010 <br /> CCA: 8883072-UT <br /> OTTL License # : 08- 1740 PASS / FAIL / INCONCLUSIVE <br /> Trainee : PASS / FAIL / INCONCLUSIVE <br /> PASS / FAIL / INCONCLUSIVE <br /> EQUIPMENT: PETRO TITE LINE TESTER <br />