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BANKS 5 CON 1EQUOTNIEHi • MUM • 9MIMaUAIrn®m • 01EMW9VE <br /> PETROLEUM EQUIPMENT sno3EMT SUMOW.fWN0O F«MW01* (209)465,U56 ucENSENO 3e3550 <br /> CANPO/HILLER PL400 PIPE LINE TIGHTNESS TESTER <br /> Owner/Operator ex 4v4s4' Site Address : 44A�" W. <br /> City, St. , Zip dAAZ-1'fc A ss336 County : SAA/ .%v.va�i ✓�' <br /> Site Agent Telephone No. : <br /> Line Connected to Tank Number/Location <br /> Product Line Dispenses : .' ayL Approximate Line Length (in Feet) 30 <br /> Line Material 4TEEG Line Has P.L.L.D Yes`/ No <br /> Turbine Make / Model : i�1, A/i Ctrl Dispenser Make / Model <br /> Tank Test Equipment to be in Place During Line Test: Yes <br /> Line -to be Tested With a Line Block in Place of P.L.L.D. C / No <br /> Turbine Output Pressure = P.S. I . Test Pressure to be _ P. S. I . <br /> Time Initial Final Volume Leak Average <br /> /hoe Pressure Pressure Displaced Rate Leak Rate <br /> /6 i o STS �• -470 �- <br /> Using the Campo/Miller_P-400 Pressurized Piping Tightness Testing Equipment and test methods <br /> the results as show all /do not allow the line to be considered product tight . <br /> Final Results -p// G. P.H. <br /> Tester <br /> License r c <br /> Test Date <br /> Tester' s Signature <br /> 'sy :PEI <br />