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Maintenance/Repair Log and Site Name: &X(-aiysf gg1zr­j <br /> Address: L) _ MCA 6-11 <br /> ISD Alarm Log City: cj, <br /> ISD Alarm Date/Time <br /> as Indicated Date of <br /> Date/Time Date/Time Technician Information Component Service Performed and the <br /> Problem on Console Service Service Call a Name,Affiliation,Phone Number and Removed Outcome? <br /> � <br /> Discovered (it appiicabief Made Certification Numbers from Services <br /> 3 <br /> �211 Z-0 0 �lZ� f- -Yv1-C---. -712>/z°' <br /> z <br /> < <br /> 0 C <br /> z <br /> c.9 <br /> Ma. <br /> .. ) <br /> 'Record date and time any vapor recovery equipment problem (damaged or Wfective Vipm or ISD alarms)was discovered. <br /> zRecord the name of the ISD alarm as it reads on the ISD console. -� <br /> 3Record date and time the service call was made. M <br /> °?ecord date and time service was performed. r- <br /> tecord certified repair technician's name,company affiliatio )ne number a4 certificatio er from applicable mann' '._ �er. <br /> '-cord date and time component was taken out of service,ii .,,, ^able. v <br /> 'Record brief explanation of service performed, including outcome of service(repaired, tested and returned to service, waiting for parts,etc). Any and all actions <br /> taken to identify the cause of an ISD alarm,including the actual results of tests performed in accordance with the IOM requirements for that alarm(results <br /> may be attached),must also be noted here or in supporting documents. <br /> Rev. 81201f2� <br />