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TEST RESULT SHEET Name &Store#: <br /> Department of Environmental Health Address: <br /> Sum Juaci County City/State/Zip: �saa/� �a fSszo <br /> Contact:: G ha ko <br /> Phone#: 107- F'3R' -7674' <br /> Tank#1 Tank#2 <br /> LEAK DETECTORS Pass/F=Fail P=Pass/F=Fail <br /> l?e Ja c Ce P= <br /> Unleaded 87 i t l� 7FJ5 <br /> Plus 89 <br /> e Jcc /cam <br /> Supreme 92 Fk / d nFISS <br /> Diesel <br /> TANK MONITOR Tank#1 Tank#2 <br /> Probes <br /> Unleaded 87 <br /> Plus 89 <br /> Supreme 92 <br /> Diesel <br /> Positive Shutdown Tank#1 Tank#2 <br /> SU[ p <br /> Unleaded 87 Vbt ler Vo, /, <br /> L A G�em•z[M St[m/J <br /> Plus 89 <br /> Supreme 92 <br /> Diesel <br /> External Alarm <br /> Technician Signature Site Manager Signature <br />