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OLDT-890 Leak Detector Test Recor-4 <br /> Contractor / { Customer <br /> �10zP 4 ry/�(h Qy��OtS C JJ t 5 I��R✓�Date Location Location Product <br /> //"27-01 /T,(oO 0 l/n/ls.�� B7cc.J <br /> Tecc�hhnnician / <br /> Submersible Pump Identification <br /> Manufacturer Model No. Serial Number <br /> 06/ Ileef '; /'s`95' 82619 <br /> Leak Detector Identification <br /> Manufacturer L Description Other Style Leak Detector <br /> Diaphragm-type <br /> Piston-type fj,W of 6f,71 <br /> Tamper-proof seal installed? Yes No <br /> Leak Detector in Submersible Pump <br /> Test at Dispenser <br /> 1. Operating Pump Pressure psi (para. 15) <br /> 2. Gallons per hour rate 3 ' f7 (para.22) <br /> 3. Line pressure with pump shut off___7—psi (para. 23) <br /> 4. Bleedback Test with pump off 5'0 ml (para.26) <br /> 5. Step-through time to full flow 2 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 /> Full— <br /> Form <br /> assFailForm 890C(9-1-96) *Complete thermal expansion test before failing leak detector. <br /> 1996 Vaporless Manufacturing,Inc.,Prescott Valley,AZ <br />