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Wffoda - T 416 2nd Street Phone: (209) 744-0112 LINE & LEAK DETECTOR <br /> Galt, Ca 95632 Fax: (209) 744x0116 TEST REPORT. <br /> afforda@softcom.net <br /> CONTRACTOR/ENGINEER BAGLEY TEST DATE 8/9/19 <br /> SITE: SAN JOAQUIN GENERAL HOSPITAL <br /> 500 HOSPITAL RD FRENCH CAMP, CA 95231 <br /> Repair/Construction LOCATION SKETCH Show North <br /> Compliance ❑ Owners Request <br /> Insurance Lj Escrow SHOW STREETS, SLOGS , TANKS, ISLANDS, PIPING (IF KNOWN), PUMPS OR DISPENSERS <br /> Other IN LUE OF <br /> SHUTDOWN <br /> Make 8 Type of Pump or Dispenser <br /> RED JACKET <br /> Cover Over Lines <br /> CONCRETE <br /> Apprnx Burial Depth <br /> 3 -5 FT <br /> Weather <br /> SUNNY COOL <br /> Pressure Suction <br /> Calibrate <br /> LEAK DETECTOR FTA LEAK DETECTOR TEST INFORMATION 10 PSI <br /> Opening i Test Leak I Element <br /> KEY TYPES No/ LCD Serial Resiliency Time In Rate holding Metering Pass/ <br /> Product Key Number Seconds MUMin. PSI PSI Fall <br /> A LD 2000 <br /> B LD 2000 E <br /> C FXI V <br /> D FXI DV <br /> E STPMLD <br /> F STPMLD — D <br /> G STPMLD — E <br /> H STPMLD—D/E Notes: <br /> CONTRACTOR <br /> CERTIFICATION LINE TEST RESULTS <br /> Technician : Tests were made on the line systems as noted in accordance with test procedures <br /> ED STEARNS 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. #: EIPASS FAIT INCONCLUSIVE <br /> ICC# 8883080-UT RED DIESEL 0 . 000 <br /> OTTL License ®PASS []FAIL ❑ INCONCLUSIVE <br /> Trainee: PASS FAIL INCONCLUSIVE <br /> PASS FAIL L1 INCONCLUSIVE <br /> EQUIPMENT: PETRO TITE LINE ❑PASS ❑FAIL ❑ INCONCLUSIVE <br /> TESTER <br />