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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 1t <br /> i`;�,� <br /> Site Address: ` r � ' <br /> City: Zip: District: r <br /> DateRme of Test <br /> DISPENS RSH ' . , If l " D ATION TEST , <br /> Dispenser fueling point numbers FP: FP: <br /> Dispenser was shutdown? <br /> Fuel was unable to be dispensed from fueling points associated with the dispenser? <br /> Dispenser was re-enabled? <br /> Fuel can be dispensed from fueling points associated with the dispenser? <br /> IMVAP4.?A. : : 1�1?'ll CHECK <br /> Vapor stow meter serial number <br /> FP: FP: <br /> Dispenser fueling point numbers <br /> Low grade V/L result 91 <br /> ISD V/L value#1 <br /> Difference between V/L result#1 and ISD V/L value#1 (V/L—ISD V/L) <br /> Pass/Fail(Pass=difference within±0.15),if fail continue <br /> Low grade VIL result#2 <br /> Low grade V/L result#3 <br /> Average of 3 VIL results <br /> ISD V/L value#2 <br /> ISD VIL value#3 <br /> Average of 3 ISD V/L results <br /> Difference between Average V/L and Average ISD V/L values <br /> Pass/Fail(Pass=difference within±0.15) <br /> 1 declare, under penalty of perjury under the laws of the state of California that based on information and belief formed after reasonable <br /> inquiry,the statements and information provided in the document are true, accurate, and complete. <br /> Signature of Technician: Date: <br /> i <br />