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IN <br />:..:._�,. i �: • tE�tUIIIP IIEF�'II' • S5�]E0 • II r �1T.�ii1I'II®kY ®S5�]B3VIIC�IE <br />t11'cEQUfP iNt zao3 .eaiftot�r. o: o� • <br />=o. <br />CAHPO/N`ILLER PL400 PIPE LINE TIGHTNESS TESTER <br />Owner/Operator <br />City, St., zip <br />Site Agent <br />Line Connected to Tank Number/Location <br />Site Address .�L <br />County ag j�2 P <br />Telephone- No.: . �- <br />Product Line Dispenses Approximate Line -Length (in Feet) 660 <br />Line Material s Line Has P. L. L.O e / No <br />Turbine Make % Model r ,L/ Dispenser Make / Model ,�_/,� <br />12 <br />Tank -Test Equipment to be in Place During Line•Test: Yes / o <br />Line -to be Tested With a Line -Block in Place of P.L.L.D. es No <br />Turbine Output Pressure P. S. t: Test ,Pressure to be P,S.I. <br />Time <br />Initial <br />Final <br />Pressure <br />• r:<.. <br />Prdtsure <br />volume Leak <br />-Displaced Rate <br />Average. <br />Leak Rate <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 : -?-. G.P.N. <br />Tester License too. <br />Test Date <br />Tester's Signature <br />• :Jfit EJ:71-7Tt5r:: E+i<Tuprw• �_ <br />• Sotttta::a., S.;iORrtpn^c =•:i.o:fr�:U:1 atMlac• •uc:k=E•Sv+(a. x:+0�R1<1Ottr5116:4gESN5n0.�cH. <br />-.. <br />rao0¢R COARr .. :.,_� �- _:�:E6ur.;.t4;:O'.1rrt:.1•.., :i: ?;: <br />-.• 5'.rCt rK1e.<;:, ...�i i:aic HM+d1QQ.< ..: ^7 5 [truXK: ` - - .:ra i:::r.•' t:r. PEGu:: :.'�..�` .. :(:.', :».. _e.a. , <br />-• .. .- .:nx <br />