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I94-0112 p• 4 <br /> Jan 20 OS 09: 39a Rffa-Test f2091 <br /> R7ogit.ringSystem Certification <br /> C`�,E,1erOt� <br /> Me�ada <br /> C__{-£��,c, ;1J , i�j W el,qy Date of'resting/Servicing: <br /> Site Address: Etz <br /> v <br /> J <br /> F. In-Tank Gauging/SIR Equipment: Check this box if tank gauging is used only for inventory control <br /> Cl 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 /> RYeso* Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> o* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> No' Was accuracy of system product level readings tested? <br /> No* Wasaccuracy of system water level readings teste : <br /> No* Were all probes reinstalled properly? <br /> No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> •In the Section H,below,describe how and when these deficieneics were or will be corrected. <br /> G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. - <br /> Complete the following checklist: <br /> PfYes ❑ No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance, <br /> ❑ N/A (Check all that apply) Simulated leak rate: ❑ p•h.; ❑0.1 g.p.h ; ❑0.2 p.h. <br /> Yes ❑ No" Were all Ii confirmed operational and accurate within regulatory requirements? <br /> Yes ❑ No* 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 ❑ No" For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> 0-IT/-A <br /> LI Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if any ponioit of the monitoring system is disabled <br /> ❑-'g/A or disconnected? <br /> ❑ Yes —d—No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system <br /> malfunctions or fails a test? <br /> L ❑ Ted' For electronic LLDs,have allaccessible wiring connections been visually inspected? <br /> Ef N/A <br /> ❑ 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 be corrected. <br /> H. Comments: <br />