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A110® <br />POB 36 26515 N. Sacramento Blvd. <br />Thornton, California 95686 <br />LEAK DETECTOR <br />209 794-0102 800 524-9087 FAX 209 794-0112 <br />TEST PORT <br />Owner/Contractor/Eng: <br />TEST DATE: p `� <br />ENVIRONMENTAL HEALTH AGENCY: <br />SITE NAME: <br />Site AddressL_j LU I. <br />c ¢ 14 -:ft <br />r <br />. Lyle D. Mmm® <br />Present 0 Not Present <br />city. LY r <br />0-,W <br />-le r <br />Phone: <br />TECH SIGNATURE: 0INSPECTOR <br />J <br />NAME: <br />Operator Name: <br />U OTTL # 97-1143 <br />LEAK DETECTOR KEY <br />A LD2000 <br />C FE Petro STP -MLD <br />G Red Jacket FXIV <br />B 99LD2000 <br />W.!T z")1:R A1C --v <br />D FE Petro STP -MLD -E <br />H Red Jacket FXIVD <br />E FE Petro STP -MLD -D <br />F FE Petro STP -MLD -DE <br />J I Other <br />FTA LEAK DETECTOR TEST INFORMATION <br />Calibrated to <br />10 psi <br />Dispenser Product <br />LD Key Serial # <br />Resiliency Opening Test Leak Rate <br />Functional Metering PSI <br />Number <br />Time <br />Element <br />Pass/Fail <br />from above <br />in seconds Ivll r Minute <br />Holdin PSI <br />- <br />P <br />P/F <br />P/F <br />P/F <br />P/F <br />P/F <br />P/F <br />P/F <br />P/F <br />P/F <br />