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`OZ6l '°N Wd6ti LIOZ' -61 'lnr ;inti Pani;°ad <br />SPiH Ilueiket Testing Report Form <br />SWRCB, January 2006 , <br />Thts farm hT inlanded, or apse ! Y dwaractor, performing wool teding of'W ,pol! aontaiurnent smteturex The completed form arrd <br />prt�ataats fin»r 6esis (iJ'applteable), Should de provided r0 Che acd owner/o m3torfor submidal to rhe local re to <br />,f tl� p gre tart ggttncy. <br />1. FACILITY WORMATIONT <br />fffacilityNamo: ESCALONi NMgMARTdress: 1097 E YOSEMITE BLVDESCALON' CA, Date of Testia :ntact $1L,LPhObe. 209-838-1546 <br />A cy Was Notified of Testin :1 I-21-16 <br />Name of Local Agency Iuepeator (if present du,.* jesijW.SJV PATINAR <br />COmpaby Name-' A)FIFORUA TEST 416 2nd Street Galt, CA 95632 - - (209) 7d4 -0112)+;x: (209) 744-0116 <br />Technician Conducting Test ❑ Lyle D. Nimmo ❑ Zane A. Nimmo [3 David A. Winkler [a )Felix G. Ramirez <br />5149115 -UT 5263322.T_TT 5263373 UT 5273934 -[TT <br />Crodvniials,: ICC 5et'vloe Teat. ®SWRCB Tan1c Tester <br />OmmeRts = lude inforMation vn re Irs made rior to teshm and recommeniied ollow-zi r [lets' dreela <br />CEWMiCATION OF'1'I tUMCIAN R1D5PQrq81MI.X FOR G©NDUCTIAIC'TIIi3 TESTING : <br />J her <br />eby ceirtify Haat aq the Information, contained in this troport i®.true, xrrarate, arR!# fu illi coaatpunaee Mtlller <br />f <br />Technician's Sign <br />atuzo: Date; 12-13-16 <br />$tete laws and regulations do not crilniently require testis to be performed by a qualified contractor. Fiovrevcr. local rcquitements <br />11iay► be in a A ingent. <br />._: �. <br />"� , <br />H[1C T TMINTG INFORNtATION <br />Test Method Wad; <br />[� 'Vacuum <br />Q Other <br />Test Egnt meat Vssd: TAPE /H2O <br />Equi mint Resolution: 1116 <br />Idej** spin UuCloot (By rank <br />1 87 <br />2 <br />Number StaredProduc; erq <br />a <br />Bucket Insiallarion Typo,- <br />.DircetBury`� <br />❑'Cotttamw in: Sump <br />® D.xtect liury <br />1:1 COMi incd tat <br />Direct Bury )Direct Bury <br />® in ❑:Contained in <br />Bucket Diazheter: <br />12 <br />Sump <br />fan'Contained <br />Sum <br />Bucket Deptki: <br />14 <br />14 <br />Wait time betweaq applying. . <br />vacuo nAvater and start of test<_ <br />Test Start Time ('(', <br />1000 <br />Initial Reading (Ri): <br />14 <br />14 <br />TLS! End Tawe tTF): <br />1100 <br />1100 <br />final Reading (Rr)� <br />14 <br />14 <br />Fest Durarioa (Tt — Ti); <br />1 HOUR <br />I HOUR <br />Change in Reading (RF <br />0 <br />0 <br />PasatFali Threshold or <br />OmmeRts = lude inforMation vn re Irs made rior to teshm and recommeniied ollow-zi r [lets' dreela <br />CEWMiCATION OF'1'I tUMCIAN R1D5PQrq81MI.X FOR G©NDUCTIAIC'TIIi3 TESTING : <br />J her <br />eby ceirtify Haat aq the Information, contained in this troport i®.true, xrrarate, arR!# fu illi coaatpunaee Mtlller <br />f <br />Technician's Sign <br />atuzo: Date; 12-13-16 <br />$tete laws and regulations do not crilniently require testis to be performed by a qualified contractor. Fiovrevcr. local rcquitements <br />11iay► be in a A ingent. <br />._: �. <br />"� , <br />