Laserfiche WebLink
Ick M11'4I /AIV IGWIUMt11 I (/5,{ H-FLo/Fc,,.- /U-). <br /> DATE i s i!7 LOCATION <br /> TIME TESTING ' <br /> HORIZON LINE TESTING D E <br /> A B C D E F <br /> GRADE— <br /> PUMP TYPE-- <br /> ISOLATOR—PUMP PRESSURE— <br /> TEST PRESSURE— , <br /> INITIAL LEVEL— <br /> FINAL LEVEL— <br /> TIME STARTED— <br /> TIME COMPLETED— <br /> TESTING INTERVAL— <br /> LEAK RATE (GPH} — <br /> Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> EXISTING LEAK DETECTOR TEST <br /> MFG.& TYPE i>t p -) e–D P�- P <br /> yc � 7 yr s. <br /> SERIAL N <br /> Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail <br /> El ❑ ❑ ❑ k❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> NEW LEAK DETECTOR TEST <br /> MFG.& TYPE <br /> SERIAL N <br /> Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fall <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> AFTER TESTING <br /> Pump & Dispenser <br /> Operational Yes No Yes No Yes No Yes No Yes No Yes No <br /> ❑_ ❑ ❑ ❑ ❑– ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> I verify that the dispenser(s) work normally and that the leak detector(s) are not leaking. <br /> MGR SignatureC)G�I �(UhIC(Vl <br /> FIELD NOTES <br /> 1 <br />