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4162 d Street <br />Galt, CA 95632 <br />(209) 744-0113 Fax (209) 7440116 <br />E.O. VR -203/204 <br />VST Nozzle Bag Test Report Form <br />Permit Number: <br />Date 12-18-2013 <br />_ <br />Site Name: TRACY VALERO <br />Collapse or Expand' <br />(Yes/NQ) <br />Site Address: 2375 TRACY BLVD <br />VST <br />City: TRACY CA Zip: <br />Technician_ : DAVE WINKLER <br />VST: 1360 <br />District: SN KHER <br />Veeder-Root: B 34975 <br />NOZZLE BAG TEST <br />Nagle Number Gasoline Grade <br />Noale Type <br />Collapse or Expand' <br />(Yes/NQ) <br />1 ALL <br />VST <br />NO <br />2 ALL <br />VST <br />NO <br />3 ALL <br />VST <br />NO <br />4 ALL <br />VST <br />NO <br />5 ALL <br />VST <br />NO <br />6ALL <br />VST <br />NO <br />7 ALL <br />VST <br />NO <br />8 ALL <br />VSTNO <br />Total`Number of Nozzles 8 Number of Nozzles Tested 8 Number of Nozzles Passed 8 <br />I declare, under penalty of perjury under the laws of the state of California that based on information and belief formed <br />after reasonable inquiry, the statements and information provided in this document are true, accurate, and complete. <br />Signature of Technician: Date: 12-18-13 <br />