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fforda—Tet 416 2nd Street <br /> Galt, CA 95632 <br /> (209) 744-0113 Fax (209) 744-0116 <br /> E.O.VR-203/204 <br /> VST Nozzle Bag Test Report Form <br /> Permit Number: N-9259 Date of Test: 12/6/2018 Time: <br /> Site Name: GRIN INVESTMENTS ARCO AMPM <br /> Site Address: 6009 N. EL DORADO STREET <br /> City: STOCKTON Zip: 95207 Technician: ZANE NIMMO <br /> VST: 3000839502 <br /> District: SJVAPCD Veeder-Root: A28446 <br /> Calibration Date: N/A <br /> NOZZLE BAG TEST <br /> Nozzle Number Gasoline Grade Nozzle Type Collapse or Expand <br /> (Yes/No) <br /> 1 ALL V S T NO <br /> 2 ALL V S T NO <br /> 3 ALL V S T NO <br /> 4 ALL V S T NO <br /> 5 ALL V S T NO <br /> 6 ALL V S T NO <br /> 7 ALL V S T NO <br /> 8 ALL V S T NO <br /> 9 ALL V S T NO <br /> 10 ALL V S T NO <br /> 1 1 ALL V S T NO <br /> 12 ALL V S T NO <br /> Total Number of Nozzles 12 Number of Nozzles Tested 12 Number of Nozzles Passed 12 <br /> 1 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: 12/6/2018 <br />