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S ECTED LEAK ACTIVITY L <br /> Facility # Maintenance Release # Date <br /> Tank # Product Equipment <br /> Initiating Circumstances (e.g. inventory out-of-tolerance, leak alarm, etc. <br /> Action Taken to Correct Problem (assign numberto each step in order) Date Time Initials <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 /> H <br />