Laserfiche WebLink
. . , . .clirci, LIST . , .. ....... <br /> Facility Name: <br /> TankP: _L__ Siz !Z�C)C* 0 Product: /� <br /> Thy <br /> Tile allowable variation was exceeded. Date/Time: //9,(A90/ 3 d �p <br /> M <br /> Check off each step as it is completed. ' <br /> If completion of any of the steps reveals the reason for exceeding the <br /> allowable variation it is not necessary to complete the remainder of the <br /> steps. <br /> Step 1- Records Reviewed Date/Time: 2 - <br /> Performed By: rrl <br /> Step 2- New Reconciliation Date/Time: _ ! _ <br /> s0• <br /> RPerformed Performed BY* <br /> SteP J- El Tank Owner Notified <br /> Date/Time: � <br /> Performed By: <br /> Step 4- ❑ Records Reviewed from Date/Time: <br /> Last 0 Balance (must Performed By: <br /> be performed by qualified <br /> person) <br /> Step 5_ E] <br /> - ❑ Facility Ihysically Date/Time: <br /> Inspected for Evidence Performed By.- <br /> of Leaks <br /> Step 6- ❑ Calibration on Dispenser Date/Time.- <br /> Meters <br /> ate/Time:meters Checked Performed By: <br /> (Complete meter <br /> Calibration Check Form) <br /> Step 7- ❑ Hydrostatic Pressure Test Date/rime: <br /> on Piping Performed Performed By: <br /> Step 8- ❑ Precision Tank Test Date/Time: <br /> Performed Performed By: <br /> (Provide results to SJLHD <br /> Environmental health) <br /> Step 9- ❑ k*ollow-up investigation Date/Time: <br /> as required to be per- Perforued By: <br /> Formed by SJUID . <br /> Describe briefly the reason the allowable variation was exceeded: <br /> %� J <br /> I Nearby Certify this is a True and Accurate Report. <br /> Signature/Date: � /`�/�.Q.R` �. `c- <br /> Attach this report to inventory Reconciliation Sheet where allowable variation <br /> vas exceeded. <br />