Laserfiche WebLink
M nilcringSystemCertification •I • <br /> y. !' j p at u1 <br /> Site Address: �!1! 'e ca-4 � �utk <br /> � o r �9'��„�.(ry„+ {rnkf'gate <br /> Date of Testing/Servicing: <br /> F. In-Tank Gauging/SIR Equipment: CST Clieck this box if tank gauging is used only for inventory control. <br /> ❑ Check this box if no tank gauging or SIR equipment is installed. <br /> This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. <br /> Complete the following checklist: <br /> ❑ Yes ❑ No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br /> ❑ Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> ❑ Yes ❑ No* Was accuracy of system product level readings tested? <br /> ❑ Yes ❑ No* Was accuracy of system water level readings tested? <br /> ❑ Yes ❑ 'No* Were all probes reinstalled properly? <br /> ❑ Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> * In the Section H, below, describe how and when these deficiencies were or will he corrected. <br /> G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. <br /> Corn ple e.1he following checklist: <br /> Yes ❑ No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br /> ❑ N/A (Check all Mai apply) Simulated leak rate: �.; ❑0.1 g.p.h ; ❑ 0.2 g.p.h. <br /> ❑ Ye No* I Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> Yes No* I Was the testing apparatus properly calibrated? <br /> ❑ Yes ❑ No* For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> ❑ N/A <br /> ❑ Yes ❑ Nom.* -For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> O'N/A <br /> ❑ Yes ❑� - <br /> No*� For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br /> U-N/A or disconnected? <br /> ❑ Yes ❑ For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system <br /> pZmalfunctions or fails a test? <br /> ❑ Yes ❑ No* For electronic LLDs, have all accessible wiring connections been visually inspected? <br /> "N/A <br /> ®'Yes I ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> "In the Section H, below,describe__ ow and when these deficiencies were or will be corrected. a <br /> H. Comments: -Ps e JJ /9 g ✓Nc�o>'ti°/ D11/,p� <br /> M f+) -6 Ve- © )'f' �_'pV— a Jlq- � Z: ;i,- to I'// It0,a +—c� <br /> Page 3 of 3 osioo <br />