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r <br /> Mechanical Leak Detector Test Data Sheet <br /> 'I®ARCO Products Company DDDD��1� D <br /> MAR 1 8 2002 <br /> ENVIRONMEW HEALTH <br /> � <br /> Station # �� � Date �'� - "2 "y/ 2�Q= W T/SERVICES <br /> Address g � G4 <br /> Test Information <br /> 1 ? 4 5 <br /> -Product g, ) <br /> Manufacturer <br /> Model FX /V L,.�ZL /� f=X V <br /> Full Operating Pres"sure (psi) 'a 2 <br /> Line Bleed Back (nil) D S � <br /> Trip Time (sec) 3. 3 • �' . c <br /> Metering Pressure (psi) /�% �- <br /> F/E Holding Pressure (psi) / S 2- r ` <br /> Test Leak Rate (ml/min) (gph) / -,/-o o <br /> PASS or FAIL �/�S 5 f.�t e_ S <br /> Replaced All Failed Leak Detectors Yes No �N/A <br /> If No, Replacement To Be Completed By (Date) <br /> This letter certifies that the annual leak detector tests were performed at the above referenced facility <br /> according to the equipment manufacturers procedures and limitations and the results as listed are to my <br /> knowledge true and correct. The mechanical leak detector test pass/fail is determined using a low flow threshold <br /> trip rate of 3 gph at 10 PSI. <br /> Inspected By: Contractor S67—1b/z <br /> Technician Lic# <br /> Signature <br /> APC-3325(12/00) <br />