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Contractor Customer <br />DIALYSIS NORTH � <br />Date Location Product <br />'7-2A; -o y Iso I 7.gc,r 7.6- 41 . 7;; -,e 3 <br />Technician T® P1SPcTar.r4rsjeS 2!0-7 <br />6 -RL -6- 1WA A_7-^ A-%1 <br />Submersible Pump Identification <br />Manufacturer Model No. Serial Number <br />Leak Detector Identification <br />Manufacturer Description Other Style Leak Detector <br />r E . PE i2o <br />STP—ML 1.-11 SenlA�OZ/0L5yg <br />Diaphragm -type <br />Piston -type X. <br />Leak Detector in Submersible Pump <br />Test at Dispenser <br />1. Operating Pump Pressure 3 psi (Purging Test System) <br />2. Gallons per hour rate 3 (Leak Test Phase 1) <br />3. Line pressure with pump shut off 3 `f psi (Leak Test Phase 1) <br />4. Bleedback Test with pump off 24,5 ml (Bleed -back Test) <br />5. Step -through time to full flow • 3 7 seconds (Step -through Time) <br />6. Leak detector stays in leak search position. (Leak Test Phase 2) Yes No <br />LEAK DETECTOR TEST <br />Note: Pass = Leak detector stays m slow flow during GPH test <br />Fail = Leak detector steps through to allow full pump pressure during GPH test <br />Pass <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 DIALYSIS NORTH <br />P.O. Box 95 <br />Bella Vista, CA 96008 <br />(530)275-6667 <br />