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ZTOCKTON SERVICE STATION EQUIPMENT CO. INC. <br />808N1. UNION STREET <br />STOCKTON, CA 95205-4152 <br />PHONE 209.464.8333 FAX 209.464.8349 <br />0 0 <br />0KNEG], I•P <br />CUSTOMM—ffhMa., L��)C::, ja DATE: <br />LOCATION: <br />CITY: tgdgk-r STATE: ZIP: <br />Manufacturer <br />Manufacturer <br />FF__ fl51tvv <br />Tamper-pro6f seal installed?' <br />Leak Detector in Submersible Pump <br />Test at Dispenser <br />Q It 1 <br />1. Operating Pump Pressure C"— I -b (para. 15) <br />2. Gallons per hour rate spars. 22) <br />3. Line pressure with pump shut off (para. 23) <br />4. Bleed -Back Test with pump off 45 P .5 (para. 26) <br />'2 <br />5. Step -through time to full flow (Para. 30) <br />6. Leak detector stays in leak search position (para. 42) Yes ��N <br />LEAK DETECTOR TEST <br />Note: Pass = Leak detector fits test protocol <br />Fall = Le* detector fails test protocol <br />Pass ea <br />Fail <br />Sibinersible Pump Identific <br />Model <br />Leak Detector Identification <br />Description <br />0000 <br />Diaphragm -type <br />Piston -type <br />Yes No <br />Serial Number <br />Other Style Leak Detector <br />Form 890C <br />