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Customer Job Location Work Order <br /> Contact <br /> Site No. <br /> LEAK MONITOR INSPECnON <br /> Brand Name: V S <br /> Model Number L, 14 - o Lj Lq w k 14 L R2 i <br /> Serial Number: cd5f c, 3 `( <br /> 1) Monitor system operating properly at this time? — Yes !�:C No <br /> 2) Checked all sump floats for positive product shut off <br /> & found <br /> d�non l� <br /> 3) <br /> Pressure Line leak Detection — Yes — No _:�:C N/A <br /> @ gph for positive product shut down <br /> found <br /> l ' — Yes — No N/A <br /> 4) Checked tanktank annulaoperating r probes & found operating properly? °Z Qty � Yes — No — N/A <br /> 5) Checked piping sump probes &found opetatmg properly? <br /> 6) Checked dispenser pan robes/devices &fo operating Properly? — Yes �C No N/A <br /> 7) Checked overfill protection system( �, alang Pro& In —Qty — Yes — No N/A <br /> 8 found operating properly? �Qty � Yes — No — N/A <br /> 9) Checked �P c device 8F found pr75 <br /> o bo, Qty _Z Yes No , — N/A <br /> 2 ,� <br /> - RY MONTTOR <br /> Brand Name: <br /> Model Number: r <br /> Serial Number; <br /> 1) Monitor operating properly at this time? — Yes No <br /> 2) Paper read out available? If yes see attached. — Yes — No N/A <br /> 3) Commrntc: _ rl e? LIr C- 5,; <br /> r7 C H r <br /> cf />r ,� c2 / , c hn ✓�r2u/�,`�;r_ Off " <br /> TANK AI`g AR SPACE <br /> Check annular space between tanks for product/water? <br /> Please indicate in inches if product/water jxkTmd <br /> (on ) <br /> Tank#1 Tank#2 Tpt <br /> Yes <br /> No 7�— <br />'.) Comm <br /> echnician: Test Date: <br /> erformed by Sacramento Equipment Maintenance Company,Inc <br /> 2533 Connie Drive <br /> Sacramento. CA 95815 <br /> 916-925-2716 916-925-2816 FAX <br />