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-• i <br /> Le kw�ffizffel ll <br /> Fall Inspection Date: <br /> ,y Name: IU7 <br /> ,�#VII VV <br /> Facility Address: S <br /> k <br /> • <br /> • .�'s Name: ICC Service Technician/installer■ .. Date: <br /> AgQw <br /> Til 99, WEPM, <br /> SERVICE SERVICE <br /> -- detector <br /> Spill bucket <br /> ■ mechanical Model: <br /> 0 electronic Serial#: 0 1 hour hydrostatic 0 Incon TS-STS <br /> 0 Caldwell System 0 Other <br /> ■ line test2Lo.• f <br /> Leak detector <br /> ■ mechanical Model: <br /> ■ electronic Serial ■ <br /> ■ - programmed <br /> Caldwell System 0 Other <br /> Leak detector <br /> Spillbucket ■ minimum 5 gallon <br /> ■ mechanical Model: <br /> 0 electronic Serial#: ■ Caldwell System ■ Other <br /> sensor Primary <br /> 0 positive shutdown Model: <br /> Nil, ■ • <br /> si <br /> minutes <br /> ■ t. <br /> sensor Secondary containment testing for: <br /> ■ positive shutdownModel: i Piping <br /> ■ fail - • <br /> ■ a sensor <br /> Testing for the above components are next due • <br /> 0 positive shutdown Model: <br /> ■ fail safe Serial <br /> installation,6 months after,and every 36 months thereafter. <br /> aDrop tube with mechanicaloverfill at • f • start of r • • panel <br /> Drop tube with mechanical overfill at 95% i Corrosion protection <br /> Overfill prevention (see LG letter 150-1) <br /> TIM <br /> k �.�► � <br /> D Inspecto <br />