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S/Aaekfo'Y1 ICA '76-)6-5 <br />ANNUAL LEAK DETECTION SYSTEM REPORT <br />THIS FORM MUST BE AVAILABLE TO REGULATORY <br />INSPECTORS AT ALL TIMES, KEEP IT WITH AIR <br />QUALITY PERMIT <br />1. MECHANICAL LEAK DETECTORS <br />Make" _ TYPe Sk <br />(� (Piston or Diaphragm <br />Date Tested �,— J -1 1. <br />LEAK DETECTOR REPLACEMENTS REQUIRED <br />Regulars ', Unleaded _ Premium Other <br />(Note Product) <br />ALL LEAK DETECTORS SEALED IN PLACE Yes No <br />(Note Product(s) <br />2. ELECTRONIC MONITORING SYSTEMS <br />Waste Oil Location of Panel <br />(Lube Bay -Pay Booth -Sales Area) <br />Make Model <br />Type Date Tested <br />TLM- Annular Space <br />Tested OK Yes No Repairs Needed <br />Description <br />Product Location of Panel <br />(Lube Bay -Pay Booth -Sales Area) <br />Make Model <br />Type <br />TLM - Annular Space - Liquid or Vapor - Line Monitor <br />Date Tested Tested OK Yes <br />Re airs Needed <br />(Description) <br />tj A r, n <br />am <br />vimtiE5 <br />-- <br />SSM/}as:VKl-126wc; <br />