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EQUIPMENT TEST LOG <br />S/S #: - BUSINESS NAME: <br />Address: <br />CONTRACTOR: <br />Nome of person completing tests: <br />Siqnoture: <br />LDealer's Signature: <br />Check off each test when performed: <br />1. Lj Shear Valve Inspections - Dote: <br />Fill out this <br />form for <br />each annual <br />inspection <br />and keep <br />on file. <br />2. n Leak Detector <br />Product Model Leak -Full Line Pressure (PSI) Simulated Line Leck Test Inspection <br />Reg I r Detector Open Mox. 12 Close Min. 26 Pass Foil Dote <br />preme <br />Unleoded <br />Unleoded- <br />LD <br />jesel <br />0 t f-�e -r <br />3. J�M�ispenser <br />1. <br />2. <br />3. <br />4. <br />Meter Calibration Procedure: <br />Before starting calibration runs, wet the calibration con with product <br />and return product to storage. <br />Run 5 gallons with nozzle wide open into the con. Note gollons and <br />cubic inches drown, and return product to storage. <br />Run 5 gollons with nozzle one-half open into the con. Note gallons <br />and cubic inches drown and return product to storage. <br />If the volume measured in a 5-gollon calibration con is more than <br />6 cubic inches above or below the 5-gollon mark, the meter requires <br />calibration by a registered device repairman. <br />Fast Flow Slow Flow <br />Dote/Time Nozzle If Product 5-Gol. Draft 5-GoL Draft <br />U01. I Cu.In. Gol. I Cu.lm <br />Vol. Returned Calibration <br />to storage Required? <br />ollons; YES* NO <br />*Note <br />dote of Calibration & Device(s) used: <br />CNEW.Dov <br />02-06-92 <br />Chevron <br />No, <br />W <br />