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C <br />C <br />1998 i4itoriqdipment Testing <br />Chevron Products Caialpikny <br />6001 Bollinger Canyon Rd. <br />San Ramon, CA 94583 <br />Station No.jtof76 f <br />Make <br />Model <br />Test Date <br />Test Result <br />Date <br />Repaired <br />Testing Company and Testor <br />Comments <br />, �- qua <br />� d <br />(mm/dd/W) <br />Signature <br />Tanks: <br />1-0b <br />Q-t�;5 <br />r <br />Tank Level Monitor (TLM) <br />! <br />Annular Space Monitor <br />Turbine Sump Probe <br />r .>,_ # ,� <br />F'-jkX1, <br />1 <br />__-Y_ -7 <br />ill Sump Probe <br />Spill Containment Fill Boxes <br />Drlk ! : <br />' -- <br />f( -fit`.► <br />3j� <br />lV !� <br />;."'� <br />Mechanical Overfill Prevention <br />- <br />{ -i tEa <br />Il_r,�, <br />'l`a`y <br />KIN <br />Remflte Overfill <br />Audible and Visual Alarm <br />Electronicline <br />Pressure Monitor <br />Mechanic Leak Detector <br />- <br />Dispenser Impact Valve <br />enserSump,Probe <br />�1is <br />Emergency Shut-off Switch <br />,tA '- <br />> <br />o ,_c <br />.- <br />Return to M.L. Farrar/L1114, P.O. Box 6004, San Ramon, CA 94583 <br />1. Meets 1998 Regulations ❑ Yes ❑ No <br />2. Use comments - as needed. <br />3. 00 NOT SEND FORM IN BLANK or "DO NOT KNOW" IN SPACES. <br />White and Blue - Chevron Office <br />Canary - Station COPY: file in Tank Section of Compliance Work Book <br />U <br />4. Jest date result and date repaired (if any) must be entered or form will be returned. <br />5. Return to Chevron Office as you complete. <br />6. All forms should be completed by due date Assigned: <br />MS -978311-98} <br />Word Electronic Vasion <br />