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r- <br />1998 Monitor Equipment Testing <br />Chevron Products Company <br />6001 Bollinger Canyon Rd. <br />San Ramon, CA 94583 <br />Station No. X3574 - <br />/�w <br />015,6S-1 Alva* I <br />Make <br />Model <br />Test Date <br />Test Result <br />Date <br />Repaired <br />Testing Company and Testor Comments <br />(mm/dd/yy) <br />(mm/dd/yy) <br />Signature <br />'Tanks: - <br />Tank Level Monitor OLM) <br />114es <br />61--7w <br />ae, <br />5 C .0 7-7— Cam <br />Annular Space Mohitor <br />As -5 <br />Turbine Sump. Probe'. <br />,77- <br />914�� <br />Fill Sump Probe <br />Spill Containmentfill Boxes <br />g -7-9e <br />4P4 <br />Mechanical ill Prevention <br />/VX <br />J/0 <br />Me <br />/&rl <br />I/W /V /1V <br />Remote Overfill <br />C 9 —'r <br />9461 16-,d& <br />hlloft7p,��w <br />go— <br />-574 0 9 7 5, 7 4keft <br />Audible and Visual Alarm <br />sew <br />Electronic Line <br />Pressure Monitor <br />.rA/ <br />Ar A <br />Mechanic Leat Detector <br />Dispenser Impact Valve <br />(Jle— <br />Dispenser Sump, Probe <br />Emergency Shut -off -..Switch <br />401f <br />R etufn to M. L.- Farrar/L1114, P.O.x 6004, San Ramon, CA 94583 <br />M <br />1-Meets1994 . Regulations 1yes ❑ No 4. Test date result and date repaired (if any) must be entered or form will be returned. <br />.2. Use comments - as needed. 5. Return to Chevron Office as you complete. <br />"DO <br />3. DO NOT SEND FORM IN BLANK of NOT KNOW" IN SPACES. 6. All forms should be completed by due date Assigned: <br />-white and Blue - Chevron Office SEP 2 5 1998 MLF <br />Cana . ry - Station Copy: File in Tank Section of Compliance Work Book <br />. I . 476q— . <br />Ile, 1UZd, <br />SEP 0 9 1998 1 -- <br />MS-9783 (1-98) <br />Word Electronic Version <br />