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Ver. 1.3 – 08.07.09TP-201.1C/DLeak Rate of Drop Tube/Drain Valve Assembly and Leak Rate of Drop Tube Overfill ProtectionDevices and Spill Container Drain Valves Report FormPermit Number: Test Company:Site Name: Technician:Site Address: Certification Number Expiration DateCity: Zip: District:Date/Time of Test:DROP TUBE DRAIN VALVE AND OVERFILL PROTECTION DEVICE PRESSURE INTERGITY TESTStraight Drop Tube1Drop Tube with an Overfill Protection Device2Pressure measuring devicedigitalmanometermechanical gaugeCalibration date for pressure measuring device (must be within 180 days of the test)Ending value for digital manometer drift test if applicable (must be 0.01 in. w.c. or less) Drop Tube Drain Valve Pressure Test:Flow rate 80 ml/minDrop Tube Overfill Device Pressure Test:Flow rate 200 ml/min“Corrected” Overfill Device Leak RateTime to reach 2 in.w.c. at 80 ml/minDrain valveleak rate3FinalpressureTime to reach 2 in.w.c. at 200 ml/minOverfillleak rate3FinalpressureOverfillDeviceLeak RateMinus EqualsDrain ValveLeak RateCorrectedLeak RateTank Grade mins. ml/min in. w.c. mins. ml/min in. w.c. ml/min ml/min ml/min1234NOTES:1A straight drop tube must be tested with a bladder in place and using a flow rate of 80 ml/min.2The bladder section of TP-201.1D may be skipped if the entire drop tube passes with a leak rate below 80 ml/min.3Leak rate = nitrogen flow rate needed to maintain a constant pressure (at least 2 in. w.c.) for 30 seconds.I declare, under penalty of perjury under the laws of the state of California that based on information and belief formed after reasonable inquiry, thestatements and information provided in this document are true, accurate, and complete.Signature of Technician: ___________________________ Date: ____________________Jones Covey GroupPilot Flying J 618 Ripon Shawn Rodriguez1501 N. Jack Tone Rd.Ripon 95366 SJV-0308 06/30/202509/19/2024 @10:25am07/11/20240.00"w.c.87 3 Mins 18 Sec 0.00 ml 1.98" w.c.91 2 Mins 42 Sec 0.00 ml 2.01" w.c.09/19/2024