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Sl <br />Chevron'. Products any <br />79'S OI11tOr Equipment TCStln 6001 Bollinger Canyon Rd <br />San Ramon, CA 94583 <br />Station No. 56VJYY Date <br />p Make Model Test Date . Test Result Repaired Testing Company a <br />nd Testor Comments <br />(mm/dd/yy) (mm/dd/yy) Signature ; <br />Tanks: -1 c � f <br />Tank Level Monitor (TLM1 <br />�$ <br />Annular Space MonitorE t -1 -qb Pass_- <br />Turbine Sump Probe Chi- l <br />L <br />Fill Sump Probe lbs I_ <br />r. -CT) a' <br />Spill Containment Fill Boxes , _VIC <br />t/Iet hanical Overfill Prevention 1 <br />¢Remote Overfill kb <br />�Audible and Visual Alarm 0 W-� l� <br />'Electronic Line <br />Pressure Monitor _�! rZ <br />Mechanic Leak Detector <br />Dispenser Impact Valve C3 w <br />KI Its <br />Dispenser Sump, Probe ces I A <br />Emergency Shut-off Switch 1 <br />Return to M.L. Farrar/L1114, P.O. B ox 6004, San Ramon, CA 94583 <br />1. Meets 1998 Regulations Yes ❑ No 4. Test date result and date repaired (if any) must be entered or form will be returned. <br />2. Use comments - as needed. 5. Return to Chevron Office as you complete. <br />3. DO NOT SEND FORM IN BLANK or "DO NOT KNOW" IN SPACES. 6. All forms should be completed by due date Assigned: <br />White and Blue - Chevron Office Ms -9783 (1-98) <br />canary - Station Copy: File in Tank Section of Compliance Work Book word Electronic version <br />