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LU I t$dU - LtAK Ut I tU l C hi CONTRACTOR' / CUSTOMER 11 " DATE PROD�T LOCATION TECHNICIAN 46 I SUBMERSIBLE PUMP IDENTIFICATION CHECK MFG. LEAK DETECTOR ISOLATED TEST AT DISPENSER INDICATE MODEL NO. IF KNOWN, CHECK TYPE RECORD SERIAL # Zo�r�1 III GENERAL PUMP INFORMATION RECORD OPERATING PUMP PRESSURE Z-7, psg. RED JACKET TOKHEIM GILBARCO BENNETT DRESSER WAYNE A.O. SMITH BOWSER KEENE SOUI-H WEST OTHER MODEL 116-030 MODEL 116-017 POSITION TURN ON PUMP MODEL 116-011 A MODEL 585PM RECORD TIME IN SECONDS GUAGE PLD-2SEC DLD 2SEC V 3 GALLON PER HOUR LEAK SIMULATED TEST DLD 5SEC DLD 2SEC WITH BOTTOM SELECTOR IN 3 GPH TEST POSITION HEX HEAD HEX HEAD CALIBRATED BEAKER FOR 60 SECOND TEST ML ROUND HEAD SQUARE HEAD If LEAK DETECTOR IDENTIFICATION PRE-TEST CONDITIONS VOLUME OF PRODUCT FLUSHED THRU LINE �L GALLONS ` OTHER COMMENTS _ APR E'tiV1h01VIviEATAL HEALTH TGCT onni rnm2g: - LEAK DETECTOR INSTALLED LEAK DETECTOR ISOLATED TEST AT DISPENSER FROM PRODUCT LINE -TEST AT PUMP PIT CHECK TYPE REFER TO LDT INSTRUCTIONS Zo�r�1 III GENERAL PUMP INFORMATION RECORD OPERATING PUMP PRESSURE Z-7, psg. FLUSH LDT TESTOR AIR -VAPOR TEST WITH PUMP OFF MEASURE RECORD OPERATING PUMP PRESSURE psg. RED JACKET RED JACKET IV PRESSURE STEP TEST ED JACKET TOKHEIM OTHER MODEL 116-030 MODEL 116-017 POSITION TURN ON PUMP MODEL 116-011 A MODEL 585PM RECORD TIME IN SECONDS GUAGE PLD-2SEC DLD 2SEC V 3 GALLON PER HOUR LEAK SIMULATED TEST DLD 5SEC DLD 2SEC WITH BOTTOM SELECTOR IN 3 GPH TEST POSITION HEX HEAD HEX HEAD CALIBRATED BEAKER FOR 60 SECOND TEST ML ROUND HEAD SQUARE HEAD B) PLACE BOTTOM SELECTOR IN DISPENSER PRE-TEST CONDITIONS VOLUME OF PRODUCT FLUSHED THRU LINE �L GALLONS ` OTHER COMMENTS _ APR E'tiV1h01VIviEATAL HEALTH TGCT onni rnm2g: - LEAK DETECTOR INSTALLED LEAK DETECTOR ISOLATED TEST AT DISPENSER FROM PRODUCT LINE -TEST AT PUMP PIT REFER TO LDT INSTRUCTIONS III GENERAL LINE AND PUMP INFORMATION III GENERAL PUMP INFORMATION RECORD OPERATING PUMP PRESSURE Z-7, psg. FLUSH LDT TESTOR AIR -VAPOR TEST WITH PUMP OFF MEASURE RECORD OPERATING PUMP PRESSURE psg. AND RECORD , Gv ML IV PRESSURE STEP TEST IV PRESSURE STEP TEST -SUBMERSIBLE PUMP REMAINS ON THRU-OUT TEST PROCEDURE WITH BOTTOM SELECTOR IN PRESSURE STEP TEST WITH BOTTOM SELECTOR IN PRESSURE STEP TEST POSITION TURN ON PUMP POSITION ROTATE ISOLATOR FULLY (CC/W) RECORD TIME IN SECONDS GUAGE RECORD TIME IN SECONDS GUAGE NEEDLE REMAINS IN COLORED ZONE SEC. NEEDLE REMAINS IN COLORED ZONE SEC. V 3 GALLON PER HOUR LEAK SIMULATED TEST V 3 GALLON PER HOUR LEAK SIMULATED TEST WITH BOTTOM SELECTOR IN 3 GPH TEST POSITION WITH BOTTOM SELECTOR IN 3 GPH TEST POSITION A) MEASURE AND RECORD VOLUME IN 0 A) MEASURE AND RECORD VOLUME IN CALIBRATED BEAKER FOR 60 SECOND TEST ML CALIBRATED BEAKER FOR 60 SECOND TEST ML B) OPEN DISPENSER NOZZLE OR PLACE BOTTOM B) PLACE BOTTOM SELECTOR IN DISPENSER SELECTOR IN DISPENSER NOZZLE POSITION. NOZZLE POSITION. FLOW RATE OF APPROX. 1'h-3GAL PER MINUTE FLOW RATE OF APPROX. 112-3GAL PER MINUTE WILL BE OBSERVED. WILL BE OBSERVED. DOES GUAGE NEEDLE MOVE TO LOWER DOES GUAGE NEEDLE MOVE TO LOWER END OF COLORED ZONE YESyb END OF COLORED ZONE YES NO DOES FLOW RATE INCREASE TO APPROX. / DOES FLOW RATE INCREASE TO APPROX. 1'/2-3GAL PER MINUTE YES NO 1'/2-3GAL PER MINUTE YES NO C) CLOSE DISPENSER NOZZLE OR PLACE BOTTOM C) PLACE BOTTOM SELECTOR IN SELECTOR IN 3GPH TEST POSITION: 3GPH TEST POSITION: GUAGE RETURN TO COLORED GUAGE RETURN TO COLORED ZONE YES NO ZONE YES NO GUAGE DOES NOT RETURN TOGUAGE ' /'�NO DOES NOT RETURN TO COLORED ZONE YES COLORED ZONE YES NO GAUGE GOES TO OPERATING / GAUGE GOES TO OPERATING PRESSURE YES NO PRESSURE YES NO PASS SLEA PASS LEAK DETECTOR TEST < DETECTOR TEST FAIL FAIL PURPORA VAPORLESS FORM 880A