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ODT-890 Leak Detector Test Record` <br /> Contractor Customer <br /> Date Location �' �,�/ Product �" -- <br /> q'-P-�Z /SEYt9 4,111A, Al' z' <rY3MY 0 1 2002 <br /> Technician ENVI:r o,,1-Hi HEALTH <br /> P. ;si11iIT;SERVICES <br /> Submersible Pump Identification <br /> Manufacturer Model No. Serial Number <br /> AJ_;kcleJ <br /> //mS2ieBb' llTt <br /> Leak Detector Identification <br /> Manufacturer Description Other Style Leak Detector <br /> /e /'Fera Diaphragm-type <br /> 5f��Zb 'P Piston-type <br /> Tamper-proof sea]installed? Yes No <br /> Leak Detector in Submersible Pump <br /> Test at Dispenser <br /> '77 <br /> 1. Operating Pump Pressureo4 psi (para. 15) <br /> 2. Gallons per hour rate 3r_0 (para.22) <br /> 3. Line pressure with pump shut ofL_21. psi (para.23) <br /> 4. Bleedback Test with pump off /o D ml (para.26) <br /> 5. Step-through time to full flow—Z-1---s- seconds(para. 30) / <br /> 6. Leak detector stays in leak search position.(para.42) Yes <br /> No <br /> LEAK DETECTOR TEST <br /> Note: Pass=Leak detector fits test protocol <br /> Fail=Leak detector fails test protocol <br /> Pass <br /> Fail <br /> Form 890C(9-1-96) *Complete thermal expansion test before failing leak detector- <br /> 1996 <br /> etector1996 Vaporless Manufacturing,Inc.,Prescott Valley,AZ <br /> ",t <br /> op <br />