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AFFORDA-TE$T 416 2nd 209 Street a'744-0116 FAt CA X 32 Spill Bucket <br /> f ) 7�0112 (209) <br /> est Report <br /> TEST DATE U <br /> f !— c�,Q —O <br /> SITE NAME4-'LO Gr f r PHONE(�001 ) <br /> ADDRESS 1 CONTACT: <br /> Inspector. Present / Not Present <br /> 3.. SPILL.BUCKET TESTING INFORMATION <br /> Test Method Used: ydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used: Equipment Resolution: <br /> Identify Spill Bucket(By Tank 1 2 3 4 <br /> Number,Stored Product, etc) l C7�; <br /> Bucket Installation Type: uect Bury .irect Bury ect Bury ❑Direct Bury <br /> ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump ❑Contained in Sum <br /> Bucket Diameter: <br /> Bucket Depth: �--- <br /> Wait time between applying <br /> vacuum/water and start of test: <br /> Test Start Time(TI): <br /> Initial Reading(Rj): <br /> Test End Time(TF): <br /> Final Reading(RF): <br /> Test Duration(TF—TI): <br /> Change in Reading(RF-RI): . <br /> Pass/Fail Threshold or <br /> Criteria: <br /> Comments—(include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> Test Water: ❑Taken with tester M Left on site <br /> hereby certify that all the information contained in this report is true, <br /> accurate, and in full compliance with legal.requirements. Technician'' Lyle D. Nimmo <br /> ICC#: 5249115-UT <br /> Signature: °� ,<' ,�° i" OTTL#: 97-1143 <br /> o . .. t., F <br />