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AFFORDA-TE$T Site Name: SHORT STOP <br /> 416 2nd Street Address:20 WEST TURNER LANE <br /> Galt, CA 95632 City: LODI, CA Zip:95240 <br /> (209) 744-0112 Fax (209) 744-0116 Facility Permit #: N292-1-4 <br /> Date: 9-17-18 <br /> Technician: DAVE WINKLER <br /> District Cert #: 5273934 <br /> Healy Cert #: 1009853708 <br /> Digital Manometer Calibration Date: 7-9-18 <br /> HEALY TEST FORM <br /> Clean Air Separator Pressure Performance Test Nozzle Bag Test <br /> Fuel Grade: <br /> Nozzle Type: <br /> Initial Vacuum/ Pressure prior to test ® - ❑ + <br /> #1 #7 #13 #19 #25 #31 <br /> 1. Initial Vacuum / Pressure (W.C.) -2.0 <br /> 2.Vacuum/ Pressure after 1 minute, inches of water: -2.0 #2 #8 #14 #20 #26 #32 <br /> 3.Vacuum/ Pressure after 2 minutes, inches of water: -2.01 <br /> #3 #9 #15 #21 #27 #33 <br /> 4.Vacuum/ Pressure after 3 minutes, inches of water: -2.03 <br /> 5. Vacuum/ Pressure after 4 minutes, inches of water: -2.08 #4 #10 #16 #22 #28 #34 <br /> 6.Vacuum/ Pressure after 5 minutes, inches of water: -2.17 <br /> #5 #11 #17 #23 #29 #35 <br /> 7.Allowable final vacuum: -0.8 <br /> ® PASS ❑ FAIL #6 #12 #18 #24 #30 #36 <br /> 1 declare, under penalty of perjury under the laws of the state of California that based on information and belief formed after reasonable inquiry, the statements <br /> and information provided in the document are true, accurate, and complete. <br /> Technician Signature: W Date: 9/17/18 <br />