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Maintenance/Repair Log and Site Name: �jQdTQ—c,, ,I <br /> ISD Alarm Log Address: � _��� '-,j, s 4— <br /> Cit <br /> ISD Alarm Date/Time <br /> DatelTlme Date/Time Technician Information <br /> as IndicatedDate of Component Service Performed and the <br /> Problem p on Console Service Call Service Name, Affiliation,Phone Number and Removed Outcome' <br /> Discovered fit applicabtef Made Certification Numbers from Service° <br /> X4 <br /> �11� G�;- ��r�» 1 13(► ��13i �{� �j <br /> G;,-5-5 pis /z� /l� <br /> 4-0 L-3 <br /> %� // G'cr✓ � �� C. f l 'OIt.L �,j�,� <br /> P1tj 514 Jf _ L / ►., 4:0-� P«l-e L <br /> w, <br /> j E Wqv . �- 15-(0 "6 � I- -C{ +6.W- <br /> it 2 12,C I/VI ��� <br /> L\3 j F <br /> (-Z L,\ X\ OZ= ZlZ`I -5Vo—( <br /> 4. lei( (f) C- <br /> 'Record <br /> � <br /> f" <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 /> 5Record 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 Identity 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 Insupportingdocuments. <br /> / i 1 L�, '-Rev. 20/12 <br />