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VA LESS MANUFACTURING, INC. <br />Contractor Customer <br />DIALYSIS NORTH <br />Date Location Product <br />-7—ZO-0tf 15o/ U-c.e 76- j ,r'/) IeA,l.!G,q /c=5�2, •av�� -z- <br />Technician <br />Technician -]'o />sPEuSt),n S 2 -1 -ZS -- <br />Submersible <br />j -Z$ -" <br />Submersible Pump Identification <br />Manufacturer Model No. Serial Number <br />TACAL67' /LCEG/6cC / LLt F IA34.4G <br />Leak Detector Identification <br />Manufacturer Description Other Style Leak Detector <br />)ee-)) :UI4C►C6-r icXV SERiAG ' /®z.q?� 33!2 <br />Diaphragm -type <br />Piston -type <br />Leak Detector in Submersible Pump <br />Test at Dispenser <br />1. Operating Pump Pressure psi (Purging Test System) <br />2. Gallons per hour rate 3 (Leak Test Phase 1) <br />3. Line pressure with pump shut off 3 -5- psi (Leak Test Phase 1) <br />4. Bleedback Test with pump off 32, n ml (Bleed -back Test) <br />5. Step -through time to full flow /. V3seconds (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 premwe during GPH test <br />BM <br />Fail 70:�_4! A- - <br />*Complete thermal expansion test before failing leak detector. <br />Form 8900 (May 9, 2002) <br />2002 Vaporless Manufacturing, Inc., Prescott Valley, AZ <br />DIALYSIS NORTH <br />P.O. Box 95 <br />Bella Vista, CA 96008 <br />(530) 275-6667 <br />