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416 2nd Stre Gait CA 95632 <br />AFFORDAJE$T��(2 <br />0• 0• FAX <br />TEST DATE <br />■ y ♦ ,■ <br />Inspector: I4Eefz-� A C-10 _ resent Not Present <br />Test Water: Taken with tester [:]Left on-site <br />I hereby certify that all the information contained in this report is true, <br />accurate, and in full compliance with legal requirements. Technician: , Zane A. Nimmo <br />ICC #: 5263322 -UT <br />OTTL #: 04-1676 <br />3. SPILL BUCKET. TESTING INFORMATION <br />Test Method Used: <br />Hydrostatic <br />❑ Vacuum <br />❑ Other <br />Test Equipment Used: p1PF F- .z0 <br />Equipment Resolution: —1/6140 <br />G► <br />Identify Spill Bucket (By Tank <br />i 1 <br />2 <br />.3 <br />4 <br />tc <br />Number, Stored Product, e) <br />8� <br />-91 <br />Bucket Installation Type: <br />Direct Bury <br />Direct Bury <br />❑ Direct Bury <br />❑ Direct Bury <br />0 Contained in Sump <br />0 Contained in Sump <br />0 Contained in Sump <br />❑ Contained in Sump <br />Bucket Diameter: <br />Bucket Depth: <br />1 L( c 2 <br />1-3 <br />Wait time between applying <br />vacuundwater and start of test: <br />Test Start Time (TI): <br />p v 0 <br />Initial Reading (RI): <br />13,/ <br />Test End Time (TF): <br />v® <br />t l O b <br />Final Reading (RF): <br />l i t <br />6 Z' <br />Test Duration (TF — TI): <br />e- <br />�{ <br />Change in Reading (RF - Rt): <br />Pass[Fail Threshold or <br />Criteria: <br />Comments. - (include information on repairs made <br />prior to testing, and recommended follow-up for failed tests). <br />Test Water: Taken with tester [:]Left on-site <br />I hereby certify that all the information contained in this report is true, <br />accurate, and in full compliance with legal requirements. Technician: , Zane A. Nimmo <br />ICC #: 5263322 -UT <br />OTTL #: 04-1676 <br />