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STOCKTON SERVICE STA-11ON EQUIP <br />808 N. UNION2004 <br />STOCKTON,95205-4152 <br />PHONE 209.464.8333 FAX 209.464.8�49 <br />L D SWIMERIANWIN <br />CUSTOMER: NV Mw'- 2. JJ� DATE: <br />LOCATION: her IL <br />CITY: .5 -tort STATE: �t Y ZIP: <br />TECHNICIAN: <br />Submersible Pump Identification <br />Manufacturer Model Serial Number <br />Leak Detector Identification <br />Manufacturer Descri tion <br />f _" Cjoo x7 7a3 <br />Diaphragm -type <br />Piston -type_ <br />Tamper -proof seal installed? Yes No <br />1. <br />2. <br />3. <br />4. <br />5. <br />Other S ,tyle Leak Detector <br />Leak Detector, in Submersible Pump <br />Test at Dispenser <br />Operating Pump Pressure S (para. l5) <br />Gallons per hour rate (para. 22) <br />c <br />Line pressure with pump shut off (para. 23) <br />Bleed -Back Test with pump off �® �' f (para. 26) <br />Step -through time to full flow / 5 --V IC- (para. 30) <br />Yes No <br />6. Leak detector stays in leak search position (para. 42) <br />LEAK DETECTOR TEST <br />Note: Pass = Leak detector fits test protocol <br />F 1 =Leak detector fails test protocols .- / �� L"' /] <br />Pass C i�. �V <br />Fail <br />Form 890C <br />