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IE{@QIIIIP.5 aff <br />F�iI1EFi'II' • SSE�Sg • II �1LII.a4i�'II®kY • SgII:I3�IICE <br />PitTl:fCalJ(PfiEi�t'�`' zaa3eeeinoea;•ro;o�• <br />CAHPO/RILLER PL400 PIPE LINE TIGHTNESS TESTER <br />Owner/operator <br />City, St., Zip.ac�a G 977 <br />Site Agent <br />Site Address <br />County Scow , 1 PAFJ ✓� <br />Telephone -No.: ,�Z = sed= <br />Line Connected %o Tank Number/Location <br />Product Line Dispenses Approximate Line Length (in Feet) ggo <br />Line Material Line Has P.L.L.D�/ No <br />Turbine Make % Moder Dispenser Make / Model <br />Tank -Test Equipment to be in Place During Line - Test: Yes / <br />Line -to be Tested With a Line -Block in Place of P.L.L.D. es No <br />Turbine Output Pressure P.S.r: Test _Pressure to be P.S. I'. <br />Time <br />initial <br />Final Volume <br />/yds- <br />Pressure <br />Pressure Displaced <br />�S 19 <br />Leak Average. <br />Rate Leak .Rate <br />',4 <br />Using the Campo/Mi1ler 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 : �.,� / G_P.H_ <br />Tester License too. <br />Test. Date 5- /�• 9� <br />Tester's Signature%-�� -- <br />Kir <br />:� � _•J�•,om:..; F.tctR rw' : _ . omaa(ss�r_. - <br />on«.;iiOm�=::a; O ::S�i=KaK, �R< •,:EJ.;RrK�.>SU:�.If ..._ _ .� - - <br />;t$(OV(ttnc c:r:tiu Slab�r. =+olll(56 ` c:i:eeu.. iF 4! r,; :a•=.; <br />5tttt:.; ;p=H: ,n. RMu�.f.; .•eoOCe.[<GvtRY _ ..n - - .=C:n 7pi� <br />-' $'.Nf rd1CrK , ..•�; i.^.r:<c _ � , n i::: r.•' CG. R !, .:�0• : ..._ <br />- -• .. .- ,:nos. :;t.� �iF: •. .. .... .. ... '. <br />