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Champion Precision Testing <br />PO Box 13059 Sacramento, Ca 95813-3059 <br />(916) 927-1557 Fax (916) 927-7345 <br />Electronic Leak Detector Test Data Sheet <br />Site Name y/,,,3 (�c � - -� Date C4 -2-Z-6) " <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 gph at 10 PSI. <br />Inspected By: Contractor Champion Precision Testing, Inc <br />Technician—M " Veeder-Root # <br />Signature <br />Revision 5/01 <br />1 <br />2 <br />3 <br />4 <br />5 <br />Product <br />Manufacturer <br />o� <br />u Ve �" <br />G c' a <br />V eC-d o 1 <br />c <br />Model <br />fie, .'� <br />PLL -0 <br />lquo <br />Line Bleed Back (ml) <br />6 G <br />Check Valve Holding Pressure <br />si <br />7 <br />Test Leak Rate (ml/min) (gph) <br />PASS or FAIL <br />SfiS <br />G I <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 gph at 10 PSI. <br />Inspected By: Contractor Champion Precision Testing, Inc <br />Technician—M " Veeder-Root # <br />Signature <br />Revision 5/01 <br />