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CONTRACTOR/ENGINEER <br />ORDERING TEST <br />POB 36 26515 N. C'F{: }LINE &LEAK DETECTOR <br />THORN'�I,' ���',F PRT <br />(209)794-0102 (sob) 524-9087 TEST REPORT <br />03 FEB —3 <br />DATE /— 7 1' 625 <br />SITE: 1`®�.�C �C� �1r"a s r��orf <br />LOCATION SKETCH "°R <br />�j d ICY <br />SHOW STREETS, BLDds, TANKS. ISLANDS' PIPING F KNOWN PUMPS OR DISPENSERS <br />OPERATOR I;a dpi Station# <br />OWNER <br />SITE ADDRESS pi; <br />ADDRESS <br />LINRs}LEAK DET. <br />TANK(s)-LINE(s)-LEAK DET. <br />PHONE ) <br />PHONE <br />REASON FOR TEST <br />LOCATION SKETCH "°R <br />�j d ICY <br />SHOW STREETS, BLDds, TANKS. ISLANDS' PIPING F KNOWN PUMPS OR DISPENSERS <br />LINE(# ONLY <br />ANK(s)-LINE(s <br />LINRs}LEAK DET. <br />TANK(s)-LINE(s)-LEAK DET. <br />MAKE & PE PL TYOF <br />OR DISPENSER �%%%Q , <br />COVER OVER t <br />LMS r <br />APPROX BURIAL �+ <br />DEPTH 'If <br />WEATHER Itj <br />PRESSURE <br />SUCTION <br />LEAK DETECTOR <br />FTA LEAK DETECTOR TEST INFORMATION al prate <br />Er <br />y <br />TYPES: <br />No. <br />LD <br />Serial <br />Number <br />Resiliency <br />Open <br />Time <br />In Seconds <br />Test <br />Leak Rate <br />ML✓Min <br />unction <br />Element <br />Holdin PSI <br />etering <br />PSI <br />Yes / <br />No <br />Product <br />XLD P/N 116036-5 <br />�( <br />BFLD <br />C <br />PLD P/N 116030-5 <br />XLP P/N 116035-5 <br />DLD P/N116017-5 <br />BFLD P/N 116012-5 <br />OTHER <br />Notes <br />CONTRACTOR <br />CERTIFICATION <br />LINE TEST RESULTS <br />TESTS lfEREAIADE ON 77JELINE SYSTFMSAS NOTED INACCORDANCE RTX TEST <br />PROCEDURESPRESCRIBED FOR AS DETAILED ON THE TEST CHART ON SIDE Z <br />, OF77TIS MRM RMI RESULTSASPOLLOM <br />TECnmCIAN: Y E h 01 <br />sIONATLIRE <br />LINE IDENTIFICATION NET {VOLUME C ANGE PER HOUR <br />PETRO77 E RT. # OM93AO163 <br />UfTL LIC # 91-1143 <br />�, <br />PASS / FAIL / INCONCLUSIVE <br />PASS ,/ FAIL / INCONCLUSIVE <br />T�Si <br />PASS / FAIL / INCONCLUSIVE <br />, <br />FEATURING PETR -TITE <br />. • LINE TESTER <br />PASS / FAIL / INCONCLUSIVE <br />0 • <br />