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START-UP/NEW INSTALLATION/WARRANTY/ANNUAL TESTING FORM (Rev. 10/07) <br /> HEALY VP1000 VACUUM PUMP <br /> Date <br /> BOTH SIDES OF THIS TEST FORM MUST BE COMPLETED FOR NEW INSTALLATIONS <br /> • Start-up/ New installations-complete SIDE A and sections 3, 4, 5 and 6 of SIDE B. Submit forms to Healy <br /> Systems. <br /> • Warranty Service or Annual Testing-complete contact information, dispenser make, vacuum pump serial # <br /> and the tests in sections 1 and 2 on SIDE A and conduct the appropriate tests specified on SIDE B. Submit <br /> Forms to Healy Systems. <br /> SERVICE COMPANY NAME TELEPHONE <br /> SERVICE TECHNICIAN HEALY TECH CERT# <br /> STATION ADDRESS CITY STATE <br /> DISPENSER MAKE VACUUM PUMP SERIAL# <br /> SIDE A <br /> DISPENSER EQUIPMENT CHECKLIST-Parts A-1 and A-2 YES NO- <br /> A-1 Is all the installed dispenser hanging hardware listed in Exhibit 1 of Executive Order <br /> VR-201 or VR-202? <br /> A-2 Proper installation of the VP1000 requires the test port and ball valve on the inlet side <br /> of the vacuum pump. Are the test port and ball valve installed correctly? <br /> *If the answer to either A-1 or A-2 is NO, the Healy Warranty is Void. <br /> A-3 <br /> • THE FOLLOWING TEST WILL PERFORM A POSITIVE PRESSURE LEAK CHECK OF THE VACUUM PUMP, <br /> DISPENSER VAPOR PIPING, HANGING HARDWARE AND ALL NOZZLES ON BOTH SIDES OF THE <br /> DISPENSER. <br /> • THE VP1000 OUTLET IS NOT CONNECTED TO UNDERGROUND PIPING DURING THIS TEST. <br /> CAUTION: REGULATE GASEOUS NITROGEN TO 2.5 PSI (-70" WC) MAXIMUM BEFORE TESTING <br /> 1. Install a 0-100 inch water column (" wc) mechanical gauge at the VP1000 test port. <br /> 2. Use the water column gage positive (high) pressure port. <br /> 3. Gaseous nitrogen gas can now be connected to the outlet (exhaust) port of the VP1000. <br /> 4. Test pressure cannot exceed 70" wc. <br /> 5. Slowly introduce the gaseous nitrogen to a pressure between 60-70"wc. <br /> 6. After reaching the pressure range, close the valve supplying the gaseous nitrogen. <br /> 7. Record the initial pressure reading on the gauge -observe and record the final pressure reading after 60 seconds. <br /> 8. Leaks must be repaired when the pressure falls more than 4"we in 60 seconds. <br /> 9. Retest until all leaks have been repaired. <br /> 10. Record test results in Section A-4. <br /> A-4 Initial Pressure test reading ("wc) Pressure test reading after 60 seconds <br /> ( <br /> PRESSURE TEST "wc) <br /> 2.5 PSI (--70"wc) Maximum <br /> 8-30 <br /> CARO Approved IOM 8-Gilbarco Encore 300 E 500 Series-Executive Orders VR-201 and VR-202 <br />