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I#LOITA61 tip <br /> Inspection Date: <br /> Facility ress: <br /> 1A [tar Lam XOA Lot-",ov <br /> e Technician's Name: MMTR� <br /> Emu <br /> Leak <br /> detector <br /> mechanical Model: <br /> i 0 electronic Serial 0 Caldwell System 0 Other <br /> 0 line test programmed -- <br /> detector <br /> Spill bucket ■ minimum 5 •_ • <br /> ■ mechanical Model: <br /> ■ electronic Serial <br /> ■ <br /> Caldwell System 0 Other <br /> 0 line test Droqrammed --- <br /> Leak detector Spill bucket 0 minimum 5 gallon <br /> 0 mechanical Model: i 0 1 hour hydrostatic 0 Incon TS-STS <br /> ■ electronic ■ <br /> Caldwelli Other <br /> i line test proqrammed <br /> sensor Primary <br /> 0 positive shutdown Model: <br /> ■ Serial#: psi <br /> fail safe <br /> minutes■ NA <br /> sensor Secondary containment testing for: <br /> 0 positive shutdown Model: UDC(s) Piping <br /> ■ i fail safe Serial • <br /> ■ , ■ <br /> Testing f.. the above - next • - •. <br /> sensor <br /> 0 positive shutdown Model: <br /> ■ fail safe <br /> Serial <br /> REINSPECTIONEl NA installation,6 months after,and every 36 months thereafter. <br /> Drop tube with mechanical overfill at 95% Cold start of monitoring panel <br /> ube with mechanical overfill at 95% Cor osion protection <br /> Drop t <br /> Overfill prevention (see LG letter 150-1) Other: see below <br /> S FACILITY IS SUBJECT TO CURRENT <br /> # <br />