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TSC 1000 Leak Detector Tester <br /> DATA COLLECTION ANIS REPORT FORM <br /> Facility Name: 7 4 L Nt R 2 <br /> Facility Address: ( C L.Do,t 4-p o S7 <br /> Facility Phone: 1 e`r' -f5�-z Test Date: �/ ►/o <br /> Test Contractor: <br /> , <br /> Address: 0rc l�tis� <br /> S,4 C VZA /4���o Com! <br /> Contractor Phone#: v C - to -- <br /> Product Leak Serial Line Snft stow Flow pass <br /> Detector Number PSI PSI raw Rat: or <br /> Model <br /> PSI at 10 PSI Fail <br /> u L S-6 7 9 3 P4.ss <br /> Test <br /> Technician: ALyI n.) L, ;4/I Signature: -�.— <br /> Date: 7 a-1/0 Tune: / e o 0 <br /> Comments: <br />