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13 . QJIIIPMEM • SSALIESg • IISg'II'AILII.E11'II®Fi • S5IE�3�III�CIE <br />PETkb Ei-I(n:E(�U1P nE3VT zso�e reainoNr, 9W01- <br />CAHPO/HILLER PL400 PIPE LINE TIGHTNESS TESTER <br />Owner/Operator 4 <br />City, St., Zip . <br />Site Agent <br />Site Address /3Z�� <br />County <br />Telephone' No.: <br />Line Connected 'to Tank Number/Location v� <br />Product Line Dispenses ,p 9 Approximate Line Length (in Feet) �n <br />Line Material Line Has P.L.L.O <�/ No <br />Turbine Make j Model 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 : ys P.S.L. <br />Time Initial Final voIuiie LeakAve rage <br />/S 3o Pressure Pressure 'Displaced Rate Leak Rate <br />Using the Campo/Miller PL -400 Pressurized Piping Tightness Testing Equipment and test. methods <br />the results as shown (i�o not allow the line to be considered product tight. <br />Final Results �,�s— <br />G. P. H. <br />Tester �L9 � <br />- <br />L i cense <br />too.��- <br />Test Date <br />Tester's Signature <br />�. <br />4ECIVO... t,S->i :�usG <br />Com^ '.L • _. <br />U't PUMng _yr:•riq SlAA�r:++0171[56 <br />SHA•:. ♦:EPrrl :r• <br />:a,RCOmaRESSO:� :•.:.J, tcuCe. > 5u5i►�< <br />Puma Nf �; 14009:1CGYtRY <br />HPrp 100,+ <br />_ - •'c. <br />