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REOFINED <br /> * <br /> 4162 nd Street OCT 15 2018 <br /> ffo rd a-Te Galt, CA 95632 <br /> (209) 744-0113 FFpN(J"W4jj6 HEALTH <br /> DEPARTMENT <br /> E.O.VR-203/204 <br /> Vapor Pressure Sensor Verification Test & VST Processor Activation Pressure <br /> Test Report Form <br /> Test Company: AFFORDA TEST <br /> Permit Number:N-2522 4162 ND STREET GALT, CA 95632 <br /> 209-744-0113 FAX 209-744-0113 <br /> Site Name:WEST LANE CHEVRON Technician:ZANE NIMMO <br /> Site Address:4747 N.WEST LANE Certification Number/Expiration Date <br /> City: STOCKTON,CA Zip:95210 District: SJVAPCO <br /> Date/Time of Test: 9/19/2018 VST:3000839502 <br /> Veeder-Root:A28446 <br /> TEST INFORMATION <br /> Pressure sensor located at dispenser number(s) 1 / 2 <br /> Pressure sensor serial number 6 0 9 0 <br /> Calibration date for digital manometer(must be within 12 months of the test) 7/13/2018 <br /> Ending value for digital manometer drift test(must be 0.01 in.w.c.or less) .00 <br /> VAPOR PRESSURE SENSOR UST PRESSURE TEST <br /> UST pressure from digital manometer(in. w.c.) <br /> Pressure sensor value from TLS-350(in.w.c.) 2.077 <br /> Is Pressure Value Between-0.20 and+0.20 in.w.c.? YES <br /> VAPOR PRESSURE SENSOR AMBIENT REFERENCE TEST',' <br /> Non-calibrated pressure sensor value from TLS-350(in. w.c.) -0.032 <br /> Is pressure value between-0.20 and+0.20 in.w.c.? YES <br /> VST PROCESSOR ACTIVATION PRESSURE TESTt,2 <br /> VST processor activation pressure(in.w.c.) N/A <br /> Is the VST processor activation pressure<_0.4 in.w.c.? N/A <br /> NOTES: 'Valve must be returned to normal operating position after testing is completed. <br /> 'The ambient reference port cap must be in place after testing is completed. <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: 9/19/2018 <br /> Ver. 1.3 - 12.13.08 <br />