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RAW DATA SHEET

HEPA Filter Integrity Leak Test Result

Customer Instrument Used Date

Address Make / Model Calibrated On

Area Of Test Serial No Calibration Due On


Acceptable Upstream Conce.
Result (PASS /
Equipment ID Equipment Name Room Name Filter Code Number Leak Limit In Obtained Leakage In %
µgm/Ltr. % FAIL)
%

Test Conducted By Test Witnessed By

Name Name Name

Designation Designation Designation

Signature Signature Signature

Date Date Date

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