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VM1 <br /> RECEIVED <br /> Vaporless Manufacturing, Inc. JUL 2 7 2011 <br /> Quality Petroleum Equipment <br /> Solutions for Over 20 Years ENVIRONMENTAL HEALTH <br /> LDT- 890 Test Form & VMI Warranty Checklist DEPARTMENT <br /> October 1",2006 <br /> Test Information <br /> Date: ( r 11 Test Company: <br /> Telephone: Contact: <br /> Site LD: _ Address: "� J <br /> City: State: Zip: <br /> Type of Test Equipment: a <br /> cp\ an3�f( `J <br /> Submersible Pump Identification <br /> MFG: � Model No: Serial No: 11: � <br /> Leak Detector Identification 1 I I lid <br /> MFG: � ; <br /> ,, , Model No:( .Ir', `' Serial No: i <br /> Replacement k Detector Identification <br /> MFG: ����.�-,�-r-�/ <br /> Model No: �- IJ�<=>" ,. Serial No: <br /> Line Conditions <br /> 1. Type of Pipe: 2. Diameter of Piper 3. Length of Pipe' i . <br /> 4. Burial Depth of Leak Detector: 5. Kind of Fuel 6. Date of Last Line Test: ,.. <br /> Test Conditions <br /> 1. operating Pump Pressure: '_ 2. Gallon per hour test rate: @ 10 psi <br /> 3. Static Line Pressure(Pump Off): aD 4. Bleedback Test (Pump Off):y±, ml. <br /> 5. Step-through time to full flow 6,rte seconds (0 psi. to full pump pressure, no leak) <br /> 6. Leak detector stays in Leak Search Position with a 3 GPH leak -Yes: PASS No: FAIL <br /> 7. Was the leak detector adjusted —Yes: No: <br /> (See Website -www.vaporiess.com -Technical Bulletin 032805) <br /> Symptoms <br /> 1.Won't find 3 GPH leak: 2. Stays in Slow Flow: <br /> 3. Other: <br /> ************ If This Unit Is Returned Under Warranty Please Complete The Following <br /> Vaporless RGA#: Return By (Company): <br /> Telephone: Contact: <br /> Customer Control #: Address: <br /> City: State: ZIP: <br /> Vaporless Manufacturing, Inc. <br /> 8700 East Long Mesa Drive,Prescott Valley,Arizona 86314 <br /> 800-367-0185 928-775-5191 Tax: 928-775-5309 <br /> Email: vmiCavaporless.com website: www.vst)oriess.com <br />