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G <br />1998 Monit� Equip nt Testing <br />{ <br />Chevron Products'Irtr any <br />6001 Bollinger Canyon Rd. <br />Al <br />Sart Ramon, CA 94583 <br />Station No. /. / <br />%/U� S <br />Make <br />oriel <br />J, Test Date' <br />ATO R6sult; <br />Date <br />Repaired <br />Testin Com an and Testor .: <br />g p y <br />Comments <br />�y <br />9" ��� <br />�,'x <br />(mm/rid/YY) <br />— <br />(mm/rid/yy) <br />Signature <br />Tanks: <br />Tank Level Monito LM) <br />Annular Space Mo^ or' <br />��� <br />-� <br />s5 <br />Turbine Sump Pro r� <br />LS�it—�'v <br />S <br />Fill Sump Probe <br />Ci~L <br />Spill Containment I Boxes <br />��11� T1 <br />�i <br />�-�� <br />J <br />KI It,, <br />5.cA C <br />Mechanical Overfi) revention <br />C <br />RAte Overfill <br />- <br />Audible and Visual< rarm <br />— <br />Electronic Line <br />X14- <br />,� <br />$4jt Q <br />� <br />Pressure Monitor <�JO� <br />Mechanic Leak Deictor <br />t <br />Dispenser Impact lve <br />r <br />��i ►-� <br />SSS <br />Dispenser Sump, K be <br />L� <br />a <br />a <br />lc�.A. <br />(t <br />Emergency Shut -o <br />§ <br />i 1-O+� <br />55 <br />N 1� <br />SCA <br />,Switch�i� <br />Return to M.L.- Farrar/L1114 P.( B ox 6004, San Ramon, CA 94583 <br />lations 4. Test date date (if be entered form will be returned. <br />1. Meets 1998 Re• Yes ❑ No result and repaired any) must or <br />2. Use comments - & needed 5. Return.to Chevrgn Office as you complete. <br />3. DO NOT SEND FORM IN BLANKr "DO NOT KNOW" IN SPACES. # 6. All forms should be completed by due date Assigned: --� <br />White and Blue - Cevron Offic _ <br />Canary - Station C6py: File in T6k Section of Compliance Work Book <br />MS -9783(1-98) <br />Word Electronic Version <br />