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ff o r d a—Te t 416 2 Street Phone:(209)744-0112 Galt,Ca 95632 Fax: (209)744-0116 afforda@softeom.net E.O. VR-202 Veeder-Root In-Station Diagnostics Vapor Pressure Sensor Reference Test & Site Shutdown Test Report Form Permit Number:N-292 Test Company:AFFORDA TEST Site Name:SHORT STOP Technician: DAVE WINKLER Site Address:20 WEST TURNER LANE Certification Number Expiration Date City: LODI CA 95240 Zip:95240 District:SJV Date/Time of Test:9-17-18 VAPOR PRESSURE SENSOR UST PRESSURE TEST Calibration date for digital manometer(must be within 12 months of the test) 7-9-18 Ending value for digital manometer drift test(must be 0.01 in.w.c.or less) 0 Digital manometer ullage pressure,inches of water column(in.w.c.) 2.02 TLS console pressure sensor value,inches of water column(in.w.c.) 2.00 Is pressure value between-0.20 and+0.20 in.w.c.? PASS VAPOR PRESSURE SENSOR AMBIENT REFERENCE TEST',2 Pressure sensor located at dispenser number(s) 3-4 Pressure sensor number 7169 Non-calibrated pressure sensor value,inches of water column(in.w.c.) 0.071 Is pressure value between-0.20 and+0.20 in.w.c.? PASS SITE SHUTDOWN TESTS Test Parameter Test Result(Y/N) Was power removed from the TLS-350 console? YES Was power to the submersible pump(s)removed by the TLS-350? YES Was power restored to TLS-350 console? YES COMMENTS (Include Description of Repairs Made) NOTES: 'Valve must be returned to normal operating position after testing is completed. 'The ambient reference port cap must be in place after testing is completed. 'A certified Veeder-Root technician must perform this test. I 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 and information provided in this document are t r4te,;aid c Mot . Signature of Technician: Date: 9-17-18 ( OCT 15 2018 ENVIRONMENTAL HEALTH DEP.4RTV,Y rNTs.u;.os