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• ia• �_ IEQufflpIEM. Q,%ffIIr$3 • II ALLATII®Fi •• SZIEIgtYIIcCtE <br />• • �E����i��'I : E(aU1nn1E�1� • ' z•�.�,:sainoM: rho: .�o� • _..:.. ti..: ; �::.:. <br />CAHM/HZLLER PL4400 PIPE LINE TIGHMESS TESTER <br />Owner/Operator : /: Sw <br />Site AddressZ2 <br />City, St., Zip : p�c LIE- Z�'11 <br />County istw JPA <br />Ii✓:�.� <br />Site Agent <br />Telephone. No.: <br />Line Connected to Tank Number/Location <br />Product Line Oispenses 9A2 <br />Approximate Line Length (in <br />Feet) _ <br />Line Material <br />Line Has P. L. L.O/ No <br />Turbine Make % Model <br />01spenser Make / Model <br />Tank -Test Equipment to be in Place Ouring Line- Test: Yes / <br />Line to be Tested With a Line -Block' in Place <br />of P.L.L.D. es No <br />Turbine Output Pressure : �'_� P. S. r. <br />Test . Pressure to be <br />P.S. I. <br />Time Initial Final <br />Voiu*M, Leak <br />Average. <br />/S__ <br />/S__ Pressure Pressure <br />Displaced Rate <br />Leak Rate <br />::L/ ys— � <br />Agz� <br />Using the Campo/Miller-PL-400 Pressurized Piping Tightness Testing Equipment and test methods <br />the results as show to do not allow the line to be considered product tight. <br />Final Results _.,� / C_P.H. <br />Tester License tio. <br />Test Date <br />Tester's Signature��_ <br />.7. ith,Ke. SBu:Irt! <br />• <br />a011tt5 <br />Sita ;Ru!: StR:..:•:6plM1.� „_- G:KCOV(Rr e•na - '[4� t ' <br />rS5'n[riner.9;. .nwt0100:5 �ry� ttw>t6lc. - �• n.:.. <br />tF <br />eoo(LU:::O•^•.. <br />-• - �:nx 1. ::�., �t(L .. .,.... <br />