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E.O. VR-202 <br /> INCON In-Station Diagnostics Dispenser Shutdown Mapping Verification Test & Vapor <br /> Flow Meter V/L Check Test Report Form <br /> Permit Number: Test Company:B.Z.Service Station Maintenance, Inc. <br /> Site Name: Technician: <br /> Site Address: ( S - `-1 " <br /> City Zip:Q District: Sn-5:la-Z L- <br /> Date/Time of Test -27- al d �'� 's ✓ <br /> DISpENER SWUTDOWN Mdp 1fiEST <br /> FP <br /> Dispenser fueling point numbers <br /> �-- F <br /> Dispenser was shutdown? <br /> Fuel was unable In be dispensed from fueling points associated with the dispenser? S <br /> Dispenser was re-enabled? <br /> Fuel can be dispensed from fueling points associated with the dispenser? <br /> MSIIL <br /> A R FLOW <br /> Vapor flow meter serial number <br /> Dispenser fueling point numbers <br /> Low grade VA.result#1 <br /> ISD VA.value#1 ` <br /> Difference between V/L result#1 and ISD V/L value#1 (V(L-ISD V/L) <br /> Pass/Fail(Pass=diifference within±0.15),If fail continue <br /> Low grade V/L result#2 <br /> Low grade VA.result#3 <br /> Average of 3 VA.results <br /> ISD V/L value#2 <br /> ISD VA.value#3 <br /> Average of 3 ISD V/L results <br /> Difference between Average VA.and Average ISD VIL values <br /> Pass/Fail(Pass=difference within±0.15) <br /> 1 declare, under penalty of perjury u der the laws of the state of Cafdomia that based on information and belief formed after reasonable <br /> inquiry, the statements and info anon vided in the document are true, accurate, and complete. <br /> Signature of Technician: Date: 5-7 7 " y I <br /> Ver. 1.0— 12.26.07 <br />