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1 416 2nd Street Gait CA 956321 <br />AFFORDA-TE$T <br />744-0112 (209) 744-0116 F1X. <br />SITE NAME <br />ADDRESS <br />Inspector: *�On -vw, <br />Spill Bucket <br />-Test Report <br />TEST DATE <br />,PHONE <br />CONTACT: <br />i U N 0 6 Z a 0 8 <br />ENVIFR,Ckf,,IEN 'I HEALTH <br />res <br />ent Not Present <br />Test Water: Taken with tester r—] Lefton site <br />I hereby certify that all the information contained in this report is true, <br />accurate,in fi","I compliance with <br />an,d leg -b rquirements. Technician:' <br />FY e ICC #: 2jL! - L: T <br />--vow <br />Signature:.:'; <br />14 -"1OTTL- <br />1 LI I IV I I I <br />3. SPELL BUCKET TESTING INFORMATION <br />Test Method Used: <br />0 Hydrostatic— <br />0 Vacuum 0 Other <br />Test Equipment Used: <br />Equipment Resolution: <br />Identify Spill Bucket (By Tank <br />Number, Stored Product, etc.) <br />1 <br />2 <br />3 <br />4 <br />Bucket Installation Type: <br />Direct Bury <br />.XContained in Sump <br />0 Direct Bury <br />1'Y <br />XContained in Sump <br />0 Direct Bury <br />0 Contained in Sump <br />0 Dir ext Bury <br />I <br />El Contained in Sump <br />Bucket Diameter: <br />Bucket Depth: <br />Wait time between applying <br />vacuum/water and start of test: <br />Test Start Time (TI): <br />Initial Reading (RI): <br />Test End Time (TF): <br />I -lots <br />Final Reading (RF): <br />o <br />I <br />Test Duration (TF — TI): <br />how <br />Change in Reading (RF - Rj): <br />Pass/Fail Threshold or <br />Criteria: <br />RIMINI in <br />.Comments (include informati�irs made prior tes g, and recommended follow-up for failed tests) <br />Test Water: Taken with tester r—] Lefton site <br />I hereby certify that all the information contained in this report is true, <br />accurate,in fi","I compliance with <br />an,d leg -b rquirements. Technician:' <br />FY e ICC #: 2jL! - L: T <br />--vow <br />Signature:.:'; <br />14 -"1OTTL- <br />