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®-�- -�- <br />416 2nd Street Gait CA 95632 LINE & LEAK DETECTOR <br />(209) 744-0112 FAX (209) 744-011 TEST REPORT <br />CONTRACTOR/ENGINEER <br />TEST DATE o 1 2 <br />SITE NAME Y 1�✓V ..- <br />, . w . - PHONE <br />ADDRESS / <br />C/l v <br />Repair/Construction <br />Compliance <br />Insurance <br />Escrow <br />LOCATION SKETCH Show North <br />C) O0 <br />v � U a <br />SHOW STREETS, BLDGS, TANKS, ISLANDS, PIPING (IF KNOWN), PUMPS OR DISPENSER <br />X <br />Make & Type of Pump or Dispenser <br />Cover Over Lines <br />Approx Burial Depth <br />Weather <br />cJ U�1�1 <br />PCeSSuf a <br />Suction <br />LEAK DETECTORFTA <br />KEY TYKES <br />No/Product <br />LEAK DETECTOR TEST INFORMATION Calibrate <br />10 PSI <br />Opening I Element <br />LD Serial Time In Test Leak Holdin Pass / <br />Key Number Resiliency Seconds Rate ML/Min Metering PSI Fail <br />A <br />LD 2000 <br />B <br />LD 2000 E <br />C <br />FXI V <br />D <br />FXI DV <br />E <br />STPMLD <br />F <br />STPMLD - D <br />G <br />STPMLD - E <br />H <br />STPMLD - DIE <br />Notes, <br />CONTRACTOR <br />CERTIFICATION <br />Technician: Zane A. Nimmo <br />rd <br />LINE TEST RESULTS <br />Tests were made on the line systems as noted in accordance with test procedures <br />prescribed for as detailed on the test chart on Side 2 of this form with results as follows: <br />LINE IDENTIFICATION NET VOLUME CHANGE PER HOUR <br />PETROTITE CERT# <br />CCA0202112304R <br />OTTL Lic#04-1676 <br />�v (� <br />PASS JIAIL / INCONCLUSIVE <br />PAS / FAIL / INCONCLUSIVE <br />PASS / FAIL / INCONCLUSIVE <br />PASS / FAIL / INCONCLUSIVE <br />00C:)CD <br />, CQ ® v <br />Trainee: <br />QUIPMENT: PETRO TITE LINE TESTER <br />