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9 0 0 <br />416 2nd Street Galt CA 95632 Spill Bucket <br />AFFORDA-TE$T <br />1(209) 744-0112 (209) 744-0116 FAX'� <br />Test Report <br />all <br />TEST DATE <br />,SITE NAME tz <14 t' ( live riz C PHONE( <br />i <br />!ADDRESS PA CONTACT: <br />CA 17�0- <br />Inspector: LZIL" <br />- k7r �Aff,-AX & uzd PresenV' Not Present <br />1. SPILL BUCKET TESTING i" Irl <br />Test Method Used: 1rHy4pst4#c 0 Vacuum 0 Other <br />Test Equipment Used: E—;---nt Resolution: <br />a!-- - <br />Identify Spill Bucket (By Tank <br />Number, Stored Product, etc.) <br />1 <br />7 — <br />2 .3 <br />i3i I <br />t4 <br />Bucket Installation Type: <br />A Direct Bury <br />0 Contained in Sump <br />—FDirect Bury ADirect Bury <br />D Contained in Sump 0 Contained in <br />O -Direct Bury <br />11 Contained in Sump <br />Bucket Diameter: <br />_Sump <br />Bucket Depth: <br />13 <br />Wait time between applying <br />vacuum/water and start of test: <br />Test Start Time (Ti): <br />Initial Reading (RD: <br />Test End Time (TF): <br />Final Reading (RF): <br />IN <br />I C) Y2, <br />Test Duration (TF — Ti): <br />Change in Reading (RF - RO: <br />Pass/Fail Threshold or <br />Criteria: <br />Comments —, (include informati?W repairs made prio ting, and recomm4n46dj;K11ow-uPfor failed tests). <br />Test Water: [K]Taken with tester [:]Lefton site <br />I hereby certify that all the information contained in this report is true, <br />accurate, and in full compliance with le al requirements. Technician , <br />--- <br />ICC <br />echnician- <br />ICC #: <br />-------------- <br />Signature- <br />OTTL #: <br />Zane A. Nimmo <br />5263322 -UT <br />MM <br />