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TECHNICIAN �,� 1 , �`, CUSTOMER e <br /> DATE LOCATION 0 <br /> TIME TESTING ,y HORIZON LINE TESTING DATA SHEET <br /> A R C D E F <br /> GRADE'! <br /> PUMP TYPE-- <br /> ISOLATOR— <br /> PUMP <br /> YPE'ISOLATOR—PUMP PRESSURE-! <br /> TEST PRESSURE— <br /> INITIAL LEVEL-- <br /> FINAL LEVEL— <br /> TIME <br /> EVELTIME STARTED--- <br /> TIME COMPLETED-- <br /> TESTING INTERVAL <br /> LEAK RATE (GPH)-- <br /> Pass Fail Pass Fail Pass Fail ©s Fail <br /> Fail Pass Fd❑11 ❑s ❑ <br /> FXl$-,I1G LEAK DETECTOR TEST <br /> MFG.& TYPE <br /> SERVAL a 2.7z <br /> Paste Fail P-s Fail Pass F� Pass F� Pass F� Pass Faillj <br /> Tact GPH --- ❑ ❑ LJ n D �—} LJ <br /> Test GPH _ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> NEIN LEAK DETECTOR TEST <br /> 8 <br /> MFG.& TYPE <br /> SERIAL # <br /> Pass Fal Pass F s rail <br /> Pass Fail <br /> ❑ETE <br /> Fail <br /> ❑ EJ El <br /> LJ LJ <br /> AFTER TESTING <br /> Pump & Dispenser Yes No Yes ❑ <br /> Yes No Y s No Y❑ps No Yes No ❑ . ❑ <br /> No <br /> Operational . . ❑ ❑ ❑ <br /> 1� iit•, - ti1r iN �. {+ r ° . �,r to i -, y H +e <br /> {.�� n�ally.and[hak e lead detectors) are nok 1c�a: :". . <br /> vert{��that the dispensers} work(� r `` <br /> I 3 1R. M i.• nil k 7 , 1- t ��• ,. i',r� :' a, qn N H yt;•1� ti,?,:y i.l:,lw:.:�..ir \ :i+n7f` .d <br /> MGRSignaEure <br /> FIELD NOTES <br />