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AgLr,da—Te <br /> 4162°a Street Phone: (209)744-0112 LINE & LEAK DETECTOR <br /> Galt,Ca 95632 Fax: (209)744-0116 TEST REPORT <br /> afforda@softcom.net <br /> CONTRACTOR/ENGINEER <br /> SITE NAME:LODI MEMORIAL HOSPITAL TEST DATE 10-28-2020 <br /> SITE ADDRESS 975 S FAIRMONT PHONE (209) 339 - 7667 <br /> CITY LODI CA 95240 <br /> ❑ Repair/Construction LOCATION SKETCH Show North <br /> ® Compliance ❑ Owners Request <br /> ❑ Insurance ❑ Escrow <br /> ❑ Other <br /> Make&Type of Pump or Dispenser <br /> REDJACKET <br /> Cover Over Lines <br /> CONCRETE <br /> Approx Burial Depth <br /> 3-5 FEET <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 I 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 /> Felix Ramirez prescribed for as detailed on the test chart on Side 2 of this form with results as follows: <br /> LINE IDENTIFICATION NET VOLUME CHANGE PER HOUR <br /> PETROTITE CERT.#: CCA:020303281 IC DIESEL ®PASS ❑FAIL ❑INCONCLUSIVE _.0005 <br /> OTTL License#:08-1740 ❑PASS ❑FAIL ❑INCONCLUSIVE <br /> Trainee: ❑PASS ❑FAIL ❑INCONCLUSIVE <br /> [-]PASS ❑FAIL []INCONCLUSIVE <br /> EQUIPMENT: PETRO TITE LINE TESTER ❑PASS ❑FAIL ❑INCONCLUSIVE <br />