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• a 'ix. :x IEQQTIIIPNIEM • ZALIEZ • III501rAII.UAlrHOR S5(EIT t�III<CIE <br />• �FT��LF�(r1:EQUfPfiENT .zaos.�<8afiorrr.o, �o�• _ :.. �_•, .u: <br />CAHPO/HILLER PL400 PIPE LINE TIGHTNESS TESTER <br />Owner/Operator Site Address 7,57 - <br />City, <br />City, St. , Zip e f 7Z< County <br />Site Agent Telephone. No.: <br />Line Connected to Tank Number/Location <br />Product Line Dispenses ,P 9 Approximate Line Length (in Feet) <br />Line Material : `i� o��.���s Line Has P.L..L.D<�/ No <br />Turbine Make /Model 7�° Dispenser Make / Model <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.r. Test.Pressure to be P.S.I. <br />Tune Initial Final <br />Pressure Pressure <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 shown ow o not allow the line to be considered product tight. <br />Final Results G.P.H. <br />Tester ,�License too. <br />Test Date : /�•�f' <br />Tester's Signature : <br />� EIP <br />:u5F Fv:;t=ttt%r.: FiK1ROrea' : t•5ai':Su+(, AW COmaRESAwS _ <br />•,:FJ. tR;;Cr.. s SUStnt. - - <br />SII0.:,,;ERrn: 'UEI pFr(ttP< uc.r`; SiR: ,�,:NOZIL[56 pU?4�NCiS- cAoOi RECCe[RY ��•,a ,y - EcW<vF4t :0Ure:1 i«:..; <br />- --.5'.h'F vegG.e;: ..•17 i«wv<• Hare .< - - .:rel::: G1i.O !, :J^• .,... <br />0100. �.^O:S tauutct < _ E u:: .. tF6'S a5•ti- . <br />