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ontractor Customer <br />DIALYSIS NORTH <br />T - <br />Date Location Product <br />-;, Zo®oq 150, TAC/e ; oo c A4. ,20/9®A/G4 . E3 7 <br />Technician 7® n►SPeNgexr. l—!'Z, lS-,14 <br />c x e?., A4/zr^A.m/ <br />Submersible Pump Identification <br />Manufacturer Model No. Serial Number <br />TACtcer f 15ost js*vz:'3tocrq ®36S <br />Leak Detector Identification <br />Manufacturer Description Other Style Leak Detector <br />Ft PC-rT?.o '57-P r►tQ SEAL 4" 0309077`f <br />Diaphragm -type <br />Piston -type <br />Leak Detector in Submersible Pump <br />Test at Dispenser <br />1. Operating Pump Pressure 2-7 psi (Purging Test System) <br />2. Gallons per hour rate 3 (Leak Test Phase 1) <br />3. Line pressure with pump shut off /3 psi (Leak Test Phase 1) <br />4. Bleedback Test with pump off -2 /O ml (Bleed -back Test) <br />5. Step -through time to full flow 2, 73seconds (Step -through Time) <br />6. Leak detector stays in leak search position. (Leak Test Phase 2) Yes <br />LEAK DETECTOR TEST <br />Note: Pass = Leak detector stays in slow -flow during GPH test <br />Fail = Leak detector steps through to allow full pump pressure during GPH test <br />Pass P<15jr <br />Fail <br />*Complete thermal expansion test before failing leak detector. <br />Form 890C (May 9, 2002) <br />2002 Vaporless Manufacturing, Inc., Prescott Valley, AZ <br />No <br />DIALYSIS NORTH <br />P.O. Box 95 <br />Bella Vista, CA 96008 <br />(530)275-6667 <br />