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Gauge Information
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Company Name Testing For
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MANAGER NAME or COMMERCIAL CUSTOMER
NAME
Type a question
Existing, New or Replacing Device
Device Serial Number
Manufacturer of device
Device Size
Model Number Of Device
Type of protection
Type Of Service
Type a question
Hazard Code
Passed or Failed
Domestic
LOCATED NORTH WEST SIDE OF WAREHOUSE NEXT TO BAT
RP
PASS
Existing
2387337
Wilkins
2
975XL
Containment
Commercial
ASHLEY WARREN
60491810
DEVICE LOCATION ADDRESS
Street name: West 99th Street
House number: 4518
City: Carmel
State: IN
Postal code: 46032
Suite#:: United States
(317) 474-4990
7/13/2020
Company
ARTICTIC COMPOSIT PALLETS
(317) 960-5813
Address
Street Address: 4518 W. 99 TH ST
City: CARMEL
State / Province: IN
Postal / Zip Code: 46032
dbensheimer@gmail.com
dbensheimer@gmail.com
BENSHEIMER, DAVID M. _BF00-1786
DAVID BENSHEIMER
4133272
Check Valve #1 Held At What PISD
Closed Tight
Leaked
Check Valve #2 Held At What PISD
Closed Tight
Leaked
Date
Time
Check Valve #1 Held At What PISD
Closed Tight
Leaked
Check Valve #2 Held At What PISD
Closed Tight
Leaked
Date
Time
Check Valve #1 Held At What PISD
Closed Tight
Leaked
Check Valve #2 Held At What PISD
Closed Tight
Leaked
Pressure Differential Relief Valve Opened At What PISD
Did NOT Open
Date
Time
Check Valve #1 Held At What PSID
Closed Tight
Leaked
Check Valve #2 Held At What PSID
Closed Tight
Leaked
Pressure Differential Relief Valve Opened At What PSID
Did NOT Open
Passed or Failed
Tagged
Date
Time
Notes :
Opened At What PSID
PASSED TEST OK AT HIS TIME
RP
PASS
YES
4/16/2021 12:5
DC
RP
DC
Did NOT Open
Did OPEN
Check Valve Held At What PSID
Date
Time
Opened At What PSID
Did NOT Open
Did OPEN
Check Valve Held At What PSID
Date
Time
Air Gap
Date
Time
Testers Full Name:
Date
Time
AIR GAP ONLY Final Test Results
BENSHEIMER, DAVID M. _BF00-1786
4/19/2021 7:30
PVB
PVB
THROOMS WAREHOUSE AREA.
DC
DC
RP
RP
9
TIGHT
TIGHT
2.2
PVB
50
PVB
Measured
vertical inches
above
overflow rim
Supply size diameter
0