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POs 35 26515 N. SACTO, BL i1V'E& LEAK DETECTOR <br /> fxr C` THORNTON, CA. 95685. <br /> 249 794-0IO2 800 TEST REPORT 524-9087 <br /> �r <br /> CONTRACTOR/ENGINEER S loo , ��, �rr�� �k � TEST DAT C ? , <br /> ORDERING TEST <br /> SITE: A U G 0 3 204 <br /> OPERATOR - I Station# OWNER ENVIRONMENT HEALTH <br /> SITE ADDRESS 3g (y ADDRESS <br /> PHONE PHONE <br /> •.-... •. .... ... .... ...... . .. .�. .•...- .�- .... ...,,..ry•w. . +y. ..,xw•.. s, .... y.r r.t r»r qwr d r M s <br /> ..,...:. � ,weft.l:ar w.N.' a .. ....,.. ..•... <br /> REASON FOR TEST LOCATION SKETCH srawrrorsn <br /> Lff4i*ONLYANK(srLINE(S <br /> LINE(s}LEAK DET. T �a <br /> TANK(9)-LI?TE(5}-LEAK DET. - <br /> MAKE&TYPE OF P[1TdP <br /> OR DISPENSER f'f U l®l J i Lei <br /> COVER OVER (� • rJ C— <br /> LINES pit?�*,+�Q',f� �«���� 1�N�{' <br /> APPROXBLTR1AL p re <br /> DE m <br /> WEATTIER C' <br /> PRESSURE SUCTION show 8131 'M,BLDOs,TANK$ISLANDS:PIPING(IF RNOWNI.PUMPS OR DISPE'NSER8 <br /> FTA LEAK DETECTOR TEST INFORMATION <br /> LE.Ag DCalibrate <br /> 1010 PSI <br /> No. LD Serial Opening Test unehona eter' . Yes/ <br /> E rcex Number Resiliency Tlrrre Leak Rate Element PSI No <br /> y 7YPESe Product -� !n Secondr 1VI1/Min Haldie PSI <br /> XLD PIN 1I6036-5BFLD (XL MODEL <br /> fid <br /> C PLD P/N 116030-5 <br /> XLP PIN 116035-5 <br /> DLD PIN116017-5 <br /> BFLD PIN 116012-5 <br /> OTHER <br /> Notes <br /> CONTRACTOR. LINE TEST RESULTS <br /> CERTIFICATION TESTS RAE MADH ON 771E LJNE SYSMfSAS NOTED LV ACCORDANCE WITH TEST <br /> TECIiIIICI LE D.NIMMQ PROCEDURE•SPRESCRIBEDFOR ASDETAILEDONTHE TESTCHART ONSIDE 2 <br /> \ i y OF TI-IS MRM WITH REEULTSAS MLLOKS. <br /> sIvNATune LINE IDENTIFICATION_— NET VOLUME CANGEPER IdDUfi <br /> PET-ROTI" CERT.#090993A0163 <br /> (PASS .../U L LIC P 91-1143 FALL / INCONCLUSIVE j+ stt • . ly <br /> AS <br /> TrminmNuna PASS ,1 FAIL / INCONCLUSIVE <br /> rs�gn.r,Qa PASS 1 FAIL / INCONCLUSIVE <br /> FEATURING PETR -TITS • <br /> LINE TESTER PASS / FAIL / INCONCLUSIVE <br />