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Test Date: <br />LEAK DETECTOR TESTING <br />Facility : <br />:Technician: <br />ICC # <br />Test Information <br />Product <br />Manufacturer <br />Model <br />New Leak Detector <br />(Yes/No) <br />Serial Number <br />Electronic LD <br />(Yes/No) <br />Calibrated Test Leak <br />Rate: (189 mil/min <br />@ 10 PSI) (Yes/No) <br />Check Valve Holding <br />PSI <br />Resiliency <br />(Bleed Back MIL) <br />Slow Flow <br />Metering PSI / (N/A) <br />Turbine Shut Down <br />Electronic LD <br />(Yes/No/NA) <br />Slow Flow At Nozzle <br />(Yes/No/NA) <br />Opening Time <br />(Seconds) <br />Pass/Fail <br />This letter certifies that the annual leak detector tests were performed at the above referenced facility <br />according to the equipment manufacturers procedures and limitations and the results as listed are to my <br />knowledge true and correct. The leak detector test pass/fail is determined using a low flow threshold trip <br />rate of 3 gph at 10 PSI. <br />Technician Signature:Date: