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�►FFOQ/Q►-TET 416 2nd Street Galt CA 95632 LINE & LEAK DETECTOR <br /> (209) 744-0112 FAX (209) 744-0116 TEST REPORT <br /> CONTRACTOR/ENGINEER TEST DATE <br /> SITE NAME n jgolul*4 y-P Ll etro,� �" ( I PHONE ( ) <br /> ADDRESS <br /> B <br /> t�N at X,, <br /> Repair/Construction LOCATION SKETCH Show North <br /> Compliance <br /> Insurance <br /> Escrow <br /> Make&Type of Pump or Dispen er <br /> .-I-n <br /> -a/ I <br /> Cover Over Lines <br /> Co H & ref <br /> Approx Burial Depth <br /> Weather <br /> F' vY► . <br /> Pressure Suction I SHOW STREETS,BLDGS,TANKS, ISLANDS,PIPING(IF KNOWN), PUMPS OR DISPENSERS <br /> LEAK DETECTOR FTA LEAK DETECTOR TEST INFORMATION Calibrat <br /> 10 PSI <br /> Opening i Element <br /> LD Serial Time in Test Leak Holding Pass I <br /> KEY TYPES No/Product Key Number Resiliency Seconds Rate ML/Min PSI Metering PSI Fail <br /> A LD 2000 <br /> B LD 2000 E <br /> C FXI V <br /> D FXI DV <br /> E STPMLD <br /> F I STPMLD-D <br /> G STPMLD- E <br /> H I STPMLD- D/E Notes: <br /> CONTRACTOR LINE TEST RESULTS <br /> CERTIFICATION Tests were made on the line systems as noted in accordance with test procedures <br /> T . Nimmo prescribed for as detailed on the test chart on Side 2 of this form with results as follows: <br /> ,IDENTIFICATION NET VOLUME CHANGE PER HOUR <br /> TROTITE CERT# r 0-;/ PASS I FAIL / INCONCLUSIVE <br /> 090993AO163 <br /> OTTL LIC#90-1143 PA S / <br /> FAIL / INCONCLUSIVE <br /> Trainee: PASS / FAIL / INCONCLUSIVE <br /> PASS / FAIL / INCONCLUSIVE <br /> EQUIPMENT:PETRO TITE LINE TESTER <br />