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4 <br />V <br />Chevron <br />Chevron U.S.A. Inc. <br />I <br />EOUIPMENT TEST LOG G <br />a <br />S/S #: BUSINESS NAME: <br />Address: <br />60Sot"i't this <br />form for <br />Reguiar I <br />each annual <br />Supreme <br />Unleaded <br />CONTRACTOR: <br />inspection <br />Name of person completing tests: <br />and keep <br />Signature: <br />on file. <br />Dealer's Signature: <br />i <br />Check off each test when performed: <br />_ j <br />1. L_j Shear Valve Inspections — Dote: j <br />2. ❑ Leak Detector <br />Product Model Leak <br />Detector <br />Full Line Pressure (PSI) Simulated Line Leak Tes: ! Inszecticrn <br />Open Mex. 12 Close Mir,. 26 Pass Foil Dee <br />Reguiar I <br />Fast Flow Slow Flow <br />5 -Gal. Draft 5-Gol. Draft <br />Gal. Cu.ln. Gal. Cu.in. <br />Supreme <br />Unleaded <br />Colibrction I <br />Required- <br />YES* NO <br />i <br />i Un!eoded <br />l <br />Mese! <br />I <br />Other <br />3. !� <br />! 2. <br />! <br />3. <br />4. <br />Dispenser Meter Colibration Procedure: <br />i <br />Before starting coiibrction runs, wet the calibrgtion can with product <br />and return product to storage. <br />Run 5 gallons with nozzie wide open into the can. Note aollons and <br />c ibir inches drawn, and refiirn. prnniiCt to storage. <br />Run 5 gallons with nozzle one—half open into the can. Note gallons <br />and cubic inches drown and return product to storage. <br />if the volume measured in a 5—gallon calibration can is more than <br />6 cubic inches above or below the 5—go!lon mark, the meter requires <br />calibration by a registered device repairman. <br />Date/Time Nozzle # Product <br />Fast Flow Slow Flow <br />5 -Gal. Draft 5-Gol. Draft <br />Gal. Cu.ln. Gal. Cu.in. <br />Vol. Returned <br />to storage <br />qcllons <br />Colibrction I <br />Required- <br />YES* NO <br />i <br />! <br />I <br />I <br />I <br />*Note <br />date of Calibration & Device(s) used: <br />CHEVC 6;2E <br />