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4162"d Street Phone: (209)744-0112 LINE & LEAK DETECTOR <br /> 1 Affoda-Te t Galt,Ca 95632 Fax: (209)744-0116 TEST REPORT <br /> afforda@softcom.net <br /> CONTRACTOR/ENGINEER <br /> SITE NAME:SAN JOAQUIN HOSPITAL TEST DATE- �I3!�/f✓ <br /> SITE ADDRESS 500 WEST HOSPITAL RD PHONE ( ) - <br /> CITY FRENCH CAMP <br /> Repair/Construction LOCATION SKETCH Show North <br /> ® Compliance ❑ Owners Request <br /> ❑ yj <br /> Insurance ❑-Escrow <br /> ❑ Other :. <br /> F <br /> F <br /> Make&Type of Pump or Dispenser O x SEP 14 2010 <br /> RED JACKET <br /> SAN <br /> Cover Over Linesusi <br /> CONCRETE €? : : ,E k,ITME, T <br /> Approx Burial Depth <br /> 24' RT <br /> X <br /> Weather <br /> SUNNY <br /> ® Pressure Suction SHOW STREETS,BLDGS,TANKS,ISLANDS,PIPING(IF KNOWN),PUMPS OR DISPENSERS <br /> Calibrate <br /> LEAK DETECTOR FTA LEAK DETECTOR TEST INFORMATION 10 PSI <br /> Opening Test Leak I Element <br /> KEY TYPES No/ LD Serial Resiliency Time In Rate Holding Metering Pass/ <br /> Product Key Number Seconds ML/Min. PSI PSI Fail <br /> A LD 2000 <br /> B LD 2000 E <br /> C FXI V _ <br /> D FXI DV <br /> E STPMLD <br /> F STPMLD — D <br /> G STPMLD — E <br /> H STPMLD—D/E Notes: <br /> CONTRACTOR LINE TEST RESULTS <br /> CERTIFICATION <br /> Technician: Tests were made on the line systems as noted in accordance with test procedures <br /> prescribed for as detailed on the test chart on Side 2 of this form with results as follows: <br /> LINE IDENTIFICATION NET VOLUME CHANGE PER HOUR <br /> P1"1'RO"I'ITE CERT.#: CCA: 020303281IC RED DIE ®PASS ❑FAIL ❑INCONCLUSIVE .0000 <br /> 01"11 License#: 08-1740 PASS ❑FAIL ❑INCONCLUSIVE <br /> Trainee: PASS EIFAIL ❑INCONCLUSIVE <br /> ❑PASS-SS []INCONCLUSIVE <br /> EQUIPMENT: PETRO TITE LINE TESTER PASS ❑FAIL ❑INCONCLUSIVE <br />