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S NRCB,Jairuru-y 1002 NPage rof <br /> ry. UNDER-DISPENSER C }N'1AlVVN ' s'ESTING <br /> 'Gest Method Developed By. 0 [J1)C MAnuwturet' Rr lidustiy Slalub l'1 f'ra['cssinnal Engialeer <br /> 6:J Other(.Spsc& <br /> `l'zsl. lmd Ust d: '----- t:l Pressure <br /> Mu0 Vacuum I: btatie <br /> _ lJ Other(Spec) _ <br /> Test Etjuipuuw,t tlsecl a ` .mac-{ Ec-uiluueltl R,bnlution: <br /> a .791 aP7a M'��, ''Sr - -H—P <br /> ; , ,. : ..... <br /> ITl)C# 'LTIDC# L >OD(1# UDC#7 <br /> �u <br /> IJDC M:tilufacturer: <br /> Cllx!Deplll: <br /> Ifieigill frow UDC Bottom to__Top tc Q} <br /> of M attest Piping Penet.ja(low <br /> Boigllt f oko IJDC Bottom to -- <br /> Lo%vest tlectrical Peaelralion: ' <br /> Coaditioa of UDC prior to <br /> Portion of UDC Tested' <br /> Does Itu-bint strut dowki Nvhcu <br /> UDC seusor dete.W liquid(both l:!Yes t-1 No C1 NA ❑Yves CiNo LJ NA l-.!Ycs 17 No CJNA - <br /> tudtict ariil�►'ute�')'' ��^ <br /> "abide Shutdown nes muse tinle� ___-- <br /> Is nysteur prograo-aced for fail- y" <br /> st►fc strutdotir�►'?' D Yes C7 No 0 Yrs 0 No 0 NA ❑YCS-ONO IJNA O Yes O No DNA <br /> Was fail-stlfe eri:Fied to l7e s O No f JNA Ll Yes l.J No CI NA Cl Yes KI No CJNA Gl YeS G No ❑NA 1 <br /> Wait lime between appl)'iitg <br /> pressuteh-acuum/water and .. <br /> e <br /> slartim test Gl <br /> "est Start Tilril'. ---"te <br /> 1 <br /> InWid Readiu (lRi)' <br /> Test k.ud Time: ` — <br /> Fival R.eadir-,lR,r) <br /> Test Urir,,tiou: _ —_—.. 1 l-�.,_ _ ,�� L r <br /> Past/ ail Mutshuld ar Criteria, <br /> Fest Result: pass C]�stil fabs i l ft�:ti Wsw 0 Fai ass I�P <br /> Wars 8011t or reuiot'l for testing? .s CJ No 1 A Cres C1 No A Ye& CIN4 A .lYes C:INo - NA <br /> _W=jIs sellsoy pfc perly replaced and t7 Yes FJ NO A t l Y CJ No I.:I Yes CJ No I.` A LJ Yes l`j l to i A <br /> verified tiluctional alter'lestin r:' <br /> .Ci1nillients - (include informadon on repairs made prior to tesling, Anti recornruereded-jbilejw-ipp.for failed lcsls) � T <br /> r If the entire depth of lltc LTDC is xtot tested, specify how mucl,was tebty& if the answer to aM of the questions indicated K'illl alt <br /> aswrisL(*)is"NO"or"NA",the entire UDC must be wsled. (See SWRCB LG-160) <br /> L0/90 39vd 711H AmHO CZ96EGET99 LT :9T SOaZ/90/TT <br />