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LU I btfU - Lr -A& Ut I CU I UK Utltl.KLrb I CONTRACTOR' DATE ll > PRODUCT !!'' TECHNICIAN I SUBMERSIBLE PUMP IDENTIFICATION GUSIUMtN LOCATION l CHECK MFG. U TEST AT DISPENSER INDICATE MODEL NO. IF KNOWN 0 RECORD SERIAL #b Q _ 1- y S RED JACKET TOKHEIM GILBARCO BENNETT DRESSER WAYNE A.O. SMITH BOWSER KEENE O JACKET TOKHEIM Z MODEL 116-030 i -MODEL 116-011 A MODEL 585PM CHECK MFG. LEAK DETECTOR ISOLATED TEST AT DISPENSER INDICATE MODEL NO. IF KNOWN CHECK TYPE RECORD SERIAL #b Q _ 1- y S RED JACKET TOKHEIM GILBARCO BENNETT DRESSER WAYNE A.O. SMITH BOWSER KEENE SOUTH OTHER WEST -7 JACKET TOKHEIM OTHER MODEL 116-030 MODEL 116-017 -MODEL 116-011 A MODEL 585PM POSITION ROTATE ISOLATOR FULLY (CCNV) PLD-2SEC DLD 2SEC DLD 5SEC DLD 2SEC V 3 GALLON PER HOUR LEAK SIMULATED TEST HEX HEAD HEX HEAD - II LEAK DETECTOR IDENTIFICATION PRE-TEST CONDITIONS VOLUME OF PRODUCT FLUSHED THRU LINE -f GALLONS OTHER COMMENTS C:< c.. (alas TEST PROCEDURE LEAK DETECTOR INSTALLED LEAK DETECTOR ISOLATED TEST AT DISPENSER FROM PRODUCT LINE -TEST AT PUMP PIT CHECK TYPE REFER TO LDT INSTRUCTIONS III GENERAL LINE AND PUMP INFORMATION III GENERAL PUMP INFORMATION RECORD OPERATING PUMP PRESSURE 2-t psig. FLUSH LDT TESTOR AIR -VAPOR TEST WITH PUMP OFF MEASURE RECORD OPERATING PUMP PRESSURE prig. RED JACKET RED JACKETRED JACKET TOKHEIM OTHER MODEL 116-030 MODEL 116-017 -MODEL 116-011 A MODEL 585PM POSITION ROTATE ISOLATOR FULLY (CCNV) PLD-2SEC DLD 2SEC DLD 5SEC DLD 2SEC V 3 GALLON PER HOUR LEAK SIMULATED TEST HEX HEAD HEX HEAD ROUND HEAD SQUARE HEAD A) MEASURE AND RECORD VOLUME IN PRE-TEST CONDITIONS VOLUME OF PRODUCT FLUSHED THRU LINE -f GALLONS OTHER COMMENTS C:< c.. (alas TEST PROCEDURE LEAK DETECTOR INSTALLED LEAK DETECTOR ISOLATED TEST AT DISPENSER FROM PRODUCT LINE -TEST AT PUMP PIT REFER TO LDT INSTRUCTIONS III GENERAL LINE AND PUMP INFORMATION III GENERAL PUMP INFORMATION RECORD OPERATING PUMP PRESSURE 2-t psig. FLUSH LDT TESTOR AIR -VAPOR TEST WITH PUMP OFF MEASURE RECORD OPERATING PUMP PRESSURE prig. AND RECORD So ML IV PRESSURE STEP TEST IV PRESSURE STEP TEST- SUBMERSIBLE PUMP REMAINS ON THRU-OUT TEST PROCEDURE WITH BOTTOM SELECTOR IN PRESSURE STEP TEST WITH BOTTOM SELECTOR IN PRESSURE STEP TEST POSITION TURN ON PUMP POSITION ROTATE ISOLATOR FULLY (CCNV) RECORD TIME IN SECONDS GUAGE RECORD TIME IN SECONDS GUAGE NEEDLE REMAINS IN COLORED ZONE SEC. NEEDLE REMAINS IN COLORED ZONE SEC. V 3 GALLON PER HOUR LEAK SIMULATED TEST V 3 GALLON PER HOUR LEAK SIMULATED TEST WITH BOTTOM SELECTOR IN 3 GPH TEST POSITION WITH BOTTOM SELECTOR IN 3 GPH TEST POSITION A) MEASURE AND RECORD VOLUME IN A) MEASURE AND RECORD VOLUME IN CALIBRATED BEAKER FOR 60 SECOND TEST 13S ML CALIBRATED BEAKER FOR 60 SECOND TEST ML B) OPEN DISPENSER NOZZLE OR PLACE BOTTOM B) PLACE BOTTOM SELECTOR IN DISPENSER SELECTOR IN DISPENSER NOZZLE POSITION. NOZZLE POSITION. FLOW RATE OF APPROX. 1112-3GAL PER MINUTE FLOW RATE OF APPROX. 112-3GAL PER MINUTE WILL BE OBSERVED. WILL BE OBSERVED. DOES GUAGE NEEDLE MOVE TO LOWER/ DOES GUAGE NEEDLE MOVE TO LOWER END OF COLORED ZONE YES ✓ NO END OF COLORED ZONE YES NO DOES FLOW RATE INCREASE TO APPROX. DOES FLOW RATE INCREASE TO APPROX. 11/2-3GAL PER MINUTE YES -,-'NO 11/2-3GAL PER MINUTE YES NO C) CLOSE DISPENSER NOZZLE OR PLACE BOTTOM C) PLACE BOTTOM SELECTOR IN SELECTOR IN 3GPH TEST POSITION: 3GPH TEST POSITION: GUAGE RETURN TO COLORED GUAGE RETURN TO COLORED ZONE YES /NO ZONE YES NO GUAGE DOES NOT RETURN TO GUAGE DOES NOT RETURN TO ' COLORED ZONE YES NO COLORED ZONE YES NO GAUGE GOES TO OPERATINGGAUGE GOES TO OPERATING PRESSURE YES NO PRESSURE YES NO PASS PASS PASSLEA LEAK DETECTOR TEST DETECTOR TEST FAIL PURPORA VAPORLESS FORM 880A C 5>