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Champion Precision Testing <br />PO Box 13059 Sacramento, Ca 95813-3059 <br />('916) 927-1557 Fax (916) 927-7345 <br />Mechanical Leak Detector Test Data Sheet <br />Site 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 />knowledge true and correct. The mechanical leak detector test pass/fail is determined using a low flow <br />threshold trip rate of 3 ) gaph at 10 PSI. <br />Inspected By: Contractor_ Champion Precision Testing <br />Technician <br />/?,�Veeder-Root <br />Signature <br />Revision �!01 <br />2 <br />3 <br />4 <br />5 <br />Product <br />Manufacturer <br />Model <br />Resiliency <br />Opening Time <br />2 - <br />Test Leak Rate (mllmin) <br />(gph) <br />Metering PSI <br />PASS or FAIEL <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 />knowledge true and correct. The mechanical leak detector test pass/fail is determined using a low flow <br />threshold trip rate of 3 ) gaph at 10 PSI. <br />Inspected By: Contractor_ Champion Precision Testing <br />Technician <br />/?,�Veeder-Root <br />Signature <br />Revision �!01 <br />