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b. <br />L,x1 f `t l(1)� �►t It\;I( t <br />.�,lip <br />Owner/Operator 4/ <br />city, St., zip <br />Site Agent <br />Site Address 3 7_f�- <br />County <br />Telephone- No.: <br />Line Connected 'to Tank Number/Location <br />Product Line Dispenses ,F 7 <br />Approximate Line. Length <br />(in Feet) <br />Line Material <br />Line Has P.L.L.O. es / <br />No <br />Turbine Make Model <br />Dispenser Make / Mode 1^; <br />Tank Test Equipment to be in Place Oaring <br />Line7 Test: Yes / <br />Line -to be Tested With a Line -Block in Place of P:L.L.D. es o <br />Turbine'Output Pressure :" ,23 P.S.r. <br />Test_Pressure to be : 4' P.S.I. <br />Time Initial Final <br />volume Leak <br />Average. <br />/� oo Pressure Pressure <br />••OispTaced Rate <br />Leak Rate <br />Using the Campo/Miller-PL-400 Pressurized Piping Tightness Testing Equipment and test methods <br />the results as show ow not allow the line to be considered product tight. <br />Final Results -f �/ G.P.H. - <br />Tester er, License Wo. <br />Test Date ; _Z q� <br />Tester's Signature <br />i <br />PEIr <br />:U4iE0U•Fatiwr; (iEGilpra;: ;,;y(r:jw(, �(GO(M1�4{$b�r. <br />=•(1:.., S COmr!eC: w; �,;iJ. iCt.Kr• o SUa►1• ... _ , y , _ _ • <br />>U:L PlHi1�5-�csc:t<Q STR:.�:r+OIILLSSptlrti.�tt!•„- <br />S((A:.� ;pu': .:rS ^�•Qo0C• C[ [ uV(RY <br />-" iUQ( rr(i[tF:: ( kKS • fif!� .. ... .. - .r.. .. ... <br />