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Facility # Maintenance Release # <br />ank # <br />Initiating Circumstances (e.g. inventory out -of -tolerance, leak alarm, etc.) <br />Date <br />I Action Taken to Correct Problem (assign number to each step in order) I Date I Time I Initials I <br />Note: Staple all maintenance work acknowledgment slips to this document. <br />Attach to Equipment Monitoring Log and UST Inventory Reconciliation Log. <br />File in Tank Section of Retail Facility Compliance Workbook. <br />