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c .- . ■ T70 <br />��� .... <br />Facility Address: <br />�i <br />SERVICE <br />Leak detector <br />St A bucket . ❑ mirtirrturai S.gaffonf ' <br />mechanics! `.' Model: LD 2,000: <br />'❑ T hour•. hydrostatic ❑ bacon. TS,$TS <br />0 electronic .. Serial. �: <br />❑ 'Caldweif System ..: O Other,', <br />_ <br />'❑. line test programmed <br />-.Leak <br />• Spill, bucket 0 minimum, 5' gallon • . <br />d'6tector. <br />❑. fi' hour hydrostatic . ❑ Incdh T5 -STS . <br />jZ meohani l Model: o o ' <br />❑..yGaIdwell i ystem ❑. C7#hei <br />❑ 'efectronic Seriaf <br />❑ line test ro' rammed . <br />psi P <br />sensor'.IV, Ell <br />❑ positive shutdown ` Modal: <br />.minutes <br />fail safe Serial <br />Secondaryycontafnmertt'testing . for: , <br />[' K <br />. <br />piping <br />sensor •. , •,�;� <br />❑ <br />❑ Positive"shutdown "Model-' <br />the, above' cort�porients are ri6A due by: <br />d fail safe Serial #: <br />Not®:. Pt" be aw$rm• that r t�talnment cbmponent&.d+9 r"uir®d to bm.W*ted itooh <br />3n;t ttpn; B morMa mgr, plod evety 9B morifhs th ar8RfC8t. <br />❑Nth <br />Q <br />senor <br />❑'positive shutdown. Model: <br />.Corrosion Ootection' . <br />O fail safe Seria'I #: <br />Cather: see below . <br />❑ . <br />_ Drpptube With.t"rie'ohanical overfill at 95'% .. <br />Q <br />Drop tube with`reecitaicaf,overfftf.at'fi6°/Q .. <br />SERVICE <br />St A bucket . ❑ mirtirrturai S.gaffonf ' <br />Q <br />'❑ T hour•. hydrostatic ❑ bacon. TS,$TS <br />❑ 'Caldweif System ..: O Other,', <br />• Spill, bucket 0 minimum, 5' gallon • . <br />❑. fi' hour hydrostatic . ❑ Incdh T5 -STS . <br />❑..yGaIdwell i ystem ❑. C7#hei <br />❑ <br />psi P <br />.minutes <br />Secondaryycontafnmertt'testing . for: , <br />�t t <br />. <br />piping <br />Sumps} • _ VST(S). <br />Testing.for <br />the, above' cort�porients are ri6A due by: <br />Not®:. Pt" be aw$rm• that r t�talnment cbmponent&.d+9 r"uir®d to bm.W*ted itooh <br />3n;t ttpn; B morMa mgr, plod evety 9B morifhs th ar8RfC8t. <br />❑ <br />Gold start,of M. 6nitoriN,paheE <br />❑ <br />.Corrosion Ootection' . <br />• ❑ <br />Cather: see below . <br />EHD 23 04 a § . . <br />i�v 4f,?(iJf 2 <br />e 4 UST SEPME REQUEST INSPECTION REPORT <br />�t t <br />� <br />C <br />I <br />r Ariwi <br />r. <br />EHD 23 04 a § . . <br />i�v 4f,?(iJf 2 <br />e 4 UST SEPME REQUEST INSPECTION REPORT <br />