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C <br />-7 65,E! 'S <br />1993 MONITOR EQUIPMENT TESTING <br />r <br />V&-TENTri! ® _ � sK) <br />C'/l <br />Station # �� cJ <br />Make <br />Model <br />Test <br />Test <br />Date <br />c <br />Te i g Co. <br />I <br />- CIONAL <br />Date <br />Result <br />Repaired <br />°t.F <br />CE ONLY <br />MO/D/Y <br />MO/D/Y <br />Testor Signature <br />Isent To <br />City/County <br />9tA <br />ne <br />, <br />A/ll/V <br />Red Jacket Leak Detector <br />JAS <br />� <br />,/¢�j M. L.F.1 <br />� <F My <br />Comments: <br />Electronic Line Pressure Monitor <br />CEI, Etc. <br />Comments. <br />Annular Space Monitor <br />t f <br />�� <br />Comments: <br />Tank Level Monitor T.L.M. <br />Comments: <br />6 <br />Vadose Well Monitors <br />0") <br />Comments: Comments: <br />CHEVRON U.S.A. PRODUCTS CO. <br />2410 Camino Ramon <br />San Ramon, CA 94583 <br />MLF/bi j:0891-87(1-20-92) <br />Return to: M.L. Farrar/Maintenance - Northwest Region -- San Ramon - 10/1/93 <br />1. Please note if Suction Svstem <br />2. Use comments - as needed <br />3. DO NOT SEND FORM IN BLANK or "DO NOT KNOW" IN SPACES <br />4. Test date must be entered or form will be returned <br />