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Job No. 11a 0`r'7-`��{ Customer <br /> Technician Location <br /> License-NQ. � ���J�j {� <br /> • • Date (� �,3 —�f' _ ,l/ICitu State <br /> 2E <br /> HORIZON LINE TESTING DATA SHEET <br /> 11 2 ll 3 4 5 G <br /> GRADE <br /> i� <br /> PUMP TYPE <br /> ISOLATOR <br /> PUMP PRESSURE <br /> TEST PRESSURE 7 -1 /J �� <br /> INITIAL LEUEL (J,575 QS <br /> FINAL LEUEL <br /> TIME STARTED <br /> TIME COMPLETED Q g(f <br /> TEST INTERVAL <br /> LEAK RATE (GPH) QC► (,� D��O <br /> PRSS FFIIL Pflss FAIL Pfiss fnlL PASS FAIL PASS FR[L PASS FAIL <br /> ❑ ❑ U"] ❑ 1:1 ❑ ❑ El ❑ D ❑ ❑ <br /> EH I STI NG LEAK DETECTOR TEST <br /> MFG. & TYPE <br /> SERIAL ; Sf <br /> Pass Fait Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail <br /> Test GPH ❑ ❑ ❑ ❑ ❑ ❑ ❑ [I ❑ ❑ <br /> Test GPH ❑ ❑ R] ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> NEW LEAK DETECTOR TEST <br /> MFG. D TYPE <br /> SERIAL # <br /> Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> AFTER TESTING <br /> Pump t'r Yes No <br /> ®s No Yes No Yes No Yes No YesOispenser <br /> No <br /> Operational ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> sf I uerifg that the dispenser (s) work normalig and that the leak detector (s) are not I ng. <br /> Field Notes MGR 'Signature_ <br />