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t � 'DATE r� <br /> HORIZON LINE TESTING DATA SHEET HE <br /> c r��c � <br /> Job No. ffs Customer <br /> License No- Location 4'y '�=?7(` <br /> 1 City, State 5toeW�'P <br /> Grade ✓N� Q S 6 <br /> Purtv Type � DJ .-Pre--s C-I <br /> Isdation _ <br /> K. <br /> Pump Presswe S 'S <br /> Test Pressure `/a <br /> 1niUal Lcvd ,0ectD C <br /> • C'77-; <br /> Final Level � � _ <br /> True started <br /> T""e �et-d G 4-jC'�i0 <br /> Test Interval 1,73,0 <br /> Leak Rate ((;, {) --3 U <br /> P(2 a <br /> Pass <br /> L`} PFar <br /> Pass J <br /> ❑ Fad Pass Fail <br /> a ❑ <br /> EXISTING LEAK DETECTOR TEST E,MFG & Type ��r- � <br /> Serial No. i�% — ;I p� _ COs <br /> GPH Pass Fad Pass Fail Pass Fail paTes(P{ �1 <br /> ead <br /> ePass fad Pass_ � � ee [F21 <br /> 0 <br /> W-c & Type NEW LEAK DETECTOR TEST <br /> Serial N,x <br /> Pass Fail pQ <br /> a Fail Pass Fal Pass Fad PCc] ass <br /> a a a a Q a I I fail <br /> � <br /> Yes No d Af7� TESTING <br /> d�sP <br /> operational Q EDQ Q Q No No Yes No Yes No <br /> verify that the dsPenser(s) work normae I a s a s a s <br /> y and that the leak detector(s) are not leaking. <br /> Field Nota: Managers signature <br /> I , <br />