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INKS & CO. [EQuflflDwimir . zhum • nIMIrAILUAIro®H • 01KEWE E <br /> PETROLEUM EQUIPMENT 2403FASffiM0M.f1M.Q FORHR93701• (209)485.3456• ucNSENo.383550 <br /> CAMPO/HILLER PL400 PIPE LINE TIGHTNESS TESTER <br /> Owner/Operator :, P,9 /V w nfEt, Gbit- wx_(� Site Address :'fa0 /v. <br /> City, St. , Zip /LIVAIi56.W County : 5-1p/1/Toiyy�uiiv� <br /> Site Agent Telephone No. : <br /> Line Connected to Tank Number/location <br /> Product Line Dispenses : ,I.IAI , P!" <br /> u s Approximate Line Length (in Feet) 30 <br /> Line Material 7 TSL Line Has P.L.L.D, es No <br /> Turbine Make / Model Dispenser Make / Model «decd <br /> Tank Test Equipment to be in Place During Line Test: Yes /(Lco� <br /> Line -to be Tested With a Line Block in Place of P.L.L.D. Yes)/ No <br /> Turbine Output Pressure P.S. I . Test Pressure to be _L___ P. S. I . <br /> Time Initial Final Volume Leak Average <br /> IAI� Pressure Pressure Displaced Rate Leak Rate <br /> s &2 <br /> Using the Campo/Miller PL-40JO Pressurized P i p i ng T i ghtness Testing Equipment and test methods <br /> the results as show a low o not allow the line to be considered product tight . <br /> Final Results —Q�2(_ G.P.H. <br /> Tester _ _ y__ �i2z<!Zr✓ L i cense ttc. <br /> 9a /3�3 <br /> Test Date _.__../ 5�__ 5�__ _ <br /> Tester' s Signature <br />