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fforda Tet 416 2°`' Street Phone : (209) 744- 0112 LINE & LEAK DETECTOR <br /> Galt, Ca 95632 Fax : (209) 744-0116 TEST REPORT <br /> affords@softeom . net <br /> CONTRACTOR/ENGINEER <br /> SITE NAME : MARKS FOOD & FUEL TEST DATE 10/28/2019 <br /> SITE ADDRESS 880 EAST VICTOR ROAD PHONE (916 ) 712 - 7929 <br /> CITY LODI CA 95240 <br /> Repair/Construction LOCATION SKETCH Show North <br /> ® Compliance ❑ Owners Request <br /> Insurance ❑ Escrow <br /> Other <br /> Make & Type of Pump or Dispenser <br /> RED JACKET / GILBARCO <br /> Cover Over Lines <br /> CONCRETE <br /> Approx Burial Depth <br /> 4-5 FEET <br /> Weather <br /> COULDY <br /> ® Pressure Suction SHOW STREETS , BLDGS , TANKS , ISLANDS , PIPING (IF KNOWN ), PUMPS OR DISPENSERS <br /> Calibrate <br /> LEAK DETECTOR FTA LEAK DETECTOR TEST INFORMATION 10 PSI <br /> Opening Test Leak I Element <br /> KEY TYPES No/ LD Serial Resiliency Time In Rate Holding Metering Pass/ <br /> Product Key Number Seconds ML/Min . PSI PSI Fail <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 LINE TEST RESULTS <br /> CERTIFICATION <br /> Technician : Tests were made on the line systems as noted in accordance with test procedures <br /> FELIX RAMIREZ rescribed for as detailed on the test chart on Side 2 of this form with results as follows: <br /> if f ) LINE IDENTIFICATION NET VOLUME CHANGE PER HOUR <br /> a <br /> PETROTITE CERT. # : CCA: 0203032811C 91 OCT ® PASS ❑ FAIL ❑ INCONCLUSIVE - , 0010 <br /> OTTL License # : 08- 1740 87 OCT ® PASS ❑ FAIL ❑ INCONCLUSIVE - 60010 <br /> Trainee : DIESEL ® PASS ❑ FAIL ❑ INCONCLUSIVE - 60015 <br /> ❑ PASS ❑ FAIL ❑ INCONCLUSIVE <br /> EQUIPMENT: PETRO TITE LINE TESTER ❑ PASS [] FAIL ❑ INCONCLUSIVE <br />