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10, <br />Champiqw,-�-,A­? <br />P.O. Box 13059 <br />SmTamenbo. CA 95813-3059 <br />CA $00-660-9"3 <br />NEV 800-949-9443 <br />(916) 927-1657 <br />Fax: (916) 927-734.1 <br />Date 5 - S <br />Operator *2 6 q K5 7:63D <br />C r4 1- H " /a ey, 9a 3-3 o <br />Annual Monitor Maintenance & Systems Functional Test <br />Type of Monitor -I tSIJ50 4-/07 0 Pe- 4- 02 <br />Checked Installation & Safety Requirements <br />Performed Visual Check of Components & Connections <br />Inspected & Cleaned Tank Probes <br />Checked Fuel & Water Levels in Tank vAth Dip Stick -i, / 4 <br />Printed out System & Tank Set-up Valves :2,1 <br />Printed Diagnostic Probe Values <br />Compared Stick Readings with Probe Valves 6A <br />Checked All Programming For Accurate & Complete Data <br />System is Operational System is Non -Operational <br />Well Head Diameter -a <br />&f/(- A lu P a- L 4 Q_ <br />P <br />Technician <br />