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MYAg>ari.:\•a: ;..2..r.. <br />Date: '4 - <br />Site ID: <br />Operator: <br />Site Addr <br />City: <br />Zip: <br />Champion <br />Precision Tank Testing <br />Liccnsc No. 73848 <br />System Type: Pressure Type <br />Piping: Steel Fiberglass <br />Secondary Containment /�,�,r�y� Ye <br />Pump Operating Pressure; Wr17L' <br />Line isolation Method: Q 111E T-5LOe1, <br />Test Start Time: M o a <br />Petro - Tite Precision Line Test <br />F.O. Box 13059 <br />Sacramento CA 95813-3059 <br />CA 800-660-9443 <br />NV 800-949-9443 <br />1-916-927-1557 <br />Fax: (916) 927-7345 <br />Suction ❑ Type <br />❑ Other: <br />Yes ❑ No X Leak Detector Yes Pr No ❑ <br />150% Test Pressure 4r,; P61r <br />Test Finish Time: <br />15 Minule Readin Pressure Volume Net Change <br />Produ O rNt_p Before After Before After <br />1.) 3S o <br />21 3S� >6� tat U <br />3.1 'xi � 60 , Z� 00 -Z - <br />4. .f _l�q <br />5. k"5 0 O57 .1 ,00 <br />Line Test Criterion 10 Pass Fail ❑ <br />Bleed Back Criterion f D'�O Pass Fail ❑ -F-B 3 <br />Comments <br />15 Minute Reading Pressure Volume Net Change <br />Product Before After Before After <br />1. <br />2. <br />3. <br />4. <br />5. <br />Line Test Criterion Pass ❑ Fail ❑ <br />Bleed Back Criterion Pass ❑ Fail ❑ <br />Comments: <br />TECHNICIAN: William Campbell - LIC. 90 -1324 -SIGNATURES �__ Date:)-�;—a <br />