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Maintenance/Repair Log and <br />ISD Alarm Log <br />Site Name: ca <br />Address: S- W iIG SuN W�� <br />cit .S�i�� It T n� . C,iF q_520)` <br />Date/Time <br />Problem <br />ISD Alarm <br />as Indicated <br />on Console <br />Date/Time <br />Service Call <br />Date of <br />4 <br />Service <br />Technician Information <br />Name Affiliation Phone Number and <br />Date/Time <br />Component <br />Removed <br />Service Performed and the <br />Outcome <br />Discovered' <br />(if applicable) <br />Made3 <br />Certification Numbers <br />from Service s <br />tnf et f�t�/ r 5 cJ v <br />i�,,, <br />72-11 1,r <br />►�,"'�C C <br />2, ! l <br />f%P£^-rFl �2ds <br />Z-17- c 6 <br />► <br />2-11 1 r6 <br />--Iz-Ic <br />=x�c•� <br />-i�-liQ <br />ii�c���c� �r�� Ca�uf <br />sHvT A� W Vj <br />I <br />( cg ~ 144 <br />Q �— <br />�,: i -! /p <br />C0���, <br />w <br />24 �A <br />� }1 <br />�f <br />jsol Q�''� re l�a�iS <br />i I <br />S'u►,�r> <br />f'nS'F�Ptev� <br />4v,L to�i <br />Ctlars,n <br />'Record date and time any vapor recovery equipment problem (damaged or defective equipment or ISD alarms) was discovered. <br />2Record the name of the ISD alarm as it reads on the ISD console. <br />3Record date and time the service call was made. <br />4Record date and time service was performed. <br />SRecord certified repair technician's name, company affiliation, phone number and certification number from applicable manufacturer. <br />6Record date and time component was taken out of service, if applicable. <br />7Record brief explanation of service performed, including outcome of service (repaired, tested and returned to service, waiting for parts, etc). Any and all actions <br />taken to identify the cause of an ISD alarm, including the actual results of tests performed in accordance with the IOM requirements for that alarm (results <br />may be attached), must also be noted here or in supporting documents. <br />Rev. 8/20/12 <br />