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POB 36 26515 N. SACTO. BL, 'VELEAKDETECT®l� <br />.-' 'I'HORNTON,CA.,,� 45686. <br />209 794-0102 800 524-9087 TEST POT <br />CONTRACTOR/ENGINEER TEST DATE %- 0— 6, <br />ORDERING TEST � , <br />SITE: ,. <br />OPERATOR 6,C 2, 'w Station# OWNER <br />SITE ADDRESS r ' f ADDRESS <br />t ! , PHONE <br />�... ... ... .. ......y. ...+-..w.. ._ .. ..e... ....wwe .......-........_..�...........aPm..•........—N�..�++.N wu�H �+....�ratx.,.r..r...r«nRea°l::e,q"Mvy.kir•I.Msawtv.+ic�:F.vw^a•�e+Ove•-N:-.:;5x. ..r ..y .e...0 <br />LOCATI SKETCH rowNonn <br />fK(s}LINE(s _.....�....-,•,�„ vp yr 1`, <br />(s)sj-LLEAK DET. <br />MAKE & TYPE OF- <br />ORDMPENSER q, 1'.7 <br />COVER OVER <br />LINES <br />APPROX BURIAL. f <br />DEPTH <br />WEAIIM <br />TYPES. <br />XLD P/N 116036-5 <br />PLD P/N 116030-5 <br />qD <br />LP P/N 116035-5 <br />LD P/NI16017-5 <br />FLD P/N 116012-5 <br />r OTmx <br />1 Notes <br />CONTRACTOR. <br />CERTIFICATION <br />rECHMCIAN: YLE <br />i1GNATURE /V. <br />Y <br />PETRO•PPTE CERT. # 090 <br />UFTL LIC k M -no <br />ninco NTano <br />rainrce SigruMn <br />FEAT URINO•PETR-TIT <br />.. . 4 TATO'mc•-r-mm <br />63 <br />r <br />SNOW MREinl, BLDCk TANKS, ISI -AN D4 PIPING OF RNOWNX PUMPS OR DISPENSERS <br />FTA LEAK DETECTOR TEST INFORMATION <br />LDI Serial Opening Test[FENecmd <br />ona etersNumber Resiliency lune LeakRate ent PS1 <br />14 <br />Calibrate <br />10 PSI <br />Yes / <br />NO <br />' LINE TEST RESULTS <br />TE77S 11FREAMDE ON 771EMNE SYS7ELISAS N07ED INACCORDANCE WITH TEST <br />PROCEDURESPRESCRIBED FOR AS DETAILED ON 771E TEST CHART ON SIDE 2 <br />OF7711S MRM RTIH RESUL7SASPOEIDKS. <br />LINE IDENTIFICA TION NET VOLUME CiYANGEPER HOUR <br />.rs ! <br />5"71-p PAS / FAIL / INCONCLUSIVE <br />PASS ✓ FAIL / INCONCLUSIVE <br />"v r• e7 I FAIL / INCONCLUSIVE — .D 6� <br />PASS,. /.TAIL, / INCONCLUSIVE _ <br />