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TSC 1000 Leak Wtector Tester <br />DATA COLLECTION AND REPORT FORM <br />Facility Name: 7RL. <br />Facility Address: -0, <br />Facility Phone: g 1 -5Test Date: 3/ <br />Test Contractor: <br />Address: IS -Da-�%4Z- Arlt M- <br />15-41. <br />Contractor Phone c <br />Product <br />Leak <br />Detector <br />Model <br />Serial <br />Number <br />Line <br />PSI <br />S -dug <br />PSI <br />slow <br />now <br />PSI <br />Flow <br />Rate <br />at 10 PSI <br />Pass <br />or <br />Fail <br />7, 9 <br />9 'cL"5e--L <br />q <br />6-7 it. 5% <br />Test <br />Technician: <br />Signature: <br />Date: i Time: <br />Comments:. H /--&C,-� FC C DA,` )44-'1k <br />