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A <br />Champion Precision Testing, Inc. <br />PO Box 13059 Sacramento, Ca 95813-3059 <br />1916) 927-1557 Fax (916) 927-7345 <br />Electronic Leak Detector Test Data Sheet <br />Site Name `/ r e y 1q., ` a Date <br />Address <br />Test information <br />Comments: <br />This letter certifies that the annual leak detector tests were performed at the above referenced facility <br />according to the equipment manufacturers procedures and limitations and the results as listed are to my <br />'.mowledge true and correct. The mechanical leak detector test pass/fail is determined using a low IIow <br />threshold trip rate of 3 gph at 10 PSI. <br />Inspected By; Contractor_ Champion Precision Testing, Inc <br />Technician E4 3' cG''6'I S" Veeder-Root 9 S t 2--r <br />Signature <br />Revision i 01 <br />1 <br />Z <br />3 <br />4 <br />5 <br />Product <br />y , <br />Manufacturer <br />( Zea xg ckz <br />R <br />Model <br />Z <br />2- t{ <br />Zt . <br />Line Bleed Back (ml) <br />S <br />Check Valve Holding Pressure <br />(psi) <br />3 v <br />Test Leak Rate (mi/min) (,-ph) <br />3 <br />3 <br />PASS or FAiL <br />P� ss <br />Comments: <br />This letter certifies that the annual leak detector tests were performed at the above referenced facility <br />according to the equipment manufacturers procedures and limitations and the results as listed are to my <br />'.mowledge true and correct. The mechanical leak detector test pass/fail is determined using a low IIow <br />threshold trip rate of 3 gph at 10 PSI. <br />Inspected By; Contractor_ Champion Precision Testing, Inc <br />Technician E4 3' cG''6'I S" Veeder-Root 9 S t 2--r <br />Signature <br />Revision i 01 <br />