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VM1 0 RECEIVED <br /> Vaporless Manufacturing, Inc. <br /> Quality Petroleum Equipment DEC 212917 <br /> Solutions for Over 20 Years <br /> LDT- 890 Test Form & VMI Warranty ChecklistNVIRONINILNTAL HEALTH <br /> October 1",2006 1)1-,,pjkIzTMENT <br /> Test Information <br /> Date: 12-&o1-7_ Test Company: <br /> L <br /> Telephone: - Contact: <br /> Site I.D: - Address: UIJ, <br /> City: State: Zip: <br /> Type of Test Equipment: R-11, 0 —1--4A�' <br /> Submersible Pump Identification <br /> M F G: --D -1 - Model No: Serial No: <br /> Leak Detector Identification <br /> MFG: \10,01 Model No: I t). Serial No: <br /> Replacement Leak Detector Identification <br /> MFG: Model No: Serial No:j--U.9 <br /> Line Condition <br /> 1. Type of Pipe: 2. Diameter of Pipe: 3. Length of Pipe: <br /> 4. Burial Depth of Leak Detector: 5. Kind of Fuel: 6. Date of Last Line Test:_ <br /> Test Conditions @10 psi <br /> 1. Operating Pump Pressure:-2L- 2. Gallon per hour test rate: <br /> 3. Static Line Pressure (pump Off): 4. Bleedback Test(Pump Off): ml- <br /> 5. Step-through time to full flow--i—seconds (0 psi. to full pump pressure, no leak) <br /> 6. Leak detector stays in Leak Search Position with a 3 GPH leak -Yes:4—PASS No: FAIL <br /> 7. Was the leak detector adjusted -Yes: N o: )�— <br /> (See Website -www.vaporiess—.com -Technical Bulletin 032805) <br /> Svmptoms Won't find 3 GPH leak: 2. Stays in Slow Flow: <br /> 3. Other: <br /> If This Unit Is Returned Under Warranty Please Complete The Following <br /> Vaporless RGA#: Return By (Company): <br /> Telephone:_-- Contact: <br /> Customer Control #: Address: <br /> City: — State: Zip: <br /> Vaporless Manufacturing,Inc. <br /> 8700 East Long Mesa Drive,Prescott Valley,Arizona 86314 <br /> 800-367-0185 928-775-5191 Fax: 928-775-5309 <br /> Email: vmi@vaPor1ess-c0m Web Site: www-valIffigalgM <br />