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416 2nd Street Galt CA 95632 Spill Bucket <br /> AFFORDA®TE$T (209) 744-0112 (209) 744-0116 FAX <br /> Test ReportI <br /> TEST DATE — I` -Q <br /> SITE NAME / PHONE 7 <br /> ADDRESS �S/ j�AG/��(iyE CONTACT: Eu <br /> Inspector: („7/ 7 Present Not Present <br /> 3. SPILL BUCIKET TESTING INFORMATION <br /> Test Method Used: 4 Hydrostatic ❑Vacuum ❑Other <br /> Test Equipment.Used: —TAPE Equipment Resolution: <br /> Identify Spill Bucket(By Tank 1 g� 2 C 3 4 <br /> Number,Stored Product, etc. <br /> Bucket Installation Type: Direct Bury LDirect Bury .. ❑Direct Bury ❑Direct Bury <br /> ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump ❑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(T): 45 9 Oo p, <br /> Initial Reading(RO: 1*6° g 1 <br /> Test End Time(TF): tj 5 10 a O k <br /> Final Reading(RF): 1 <br /> Test Duration(TF—Tj): <br /> Change in Reading(RF-R): �-- <br /> Pass//Fail Threshold or <br /> Criteria: <br /> Comments.-(include information on repairs made prior t t sting, and recommended follow-up for failed tests). <br /> • <br /> Test Water: ®Takon with tester ❑Left on site <br /> I hereby certify that all the information contained in this report is true, <br /> accurate, and in full compliance with legal requirements. Technician;, Zane A. Nimmo <br /> ICC#: 5263322-UT <br /> Signature: OTTL#: 04-1676 <br />