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Site Adaress. 9600: 1250 N WILSON WP.Y 95202 ` Dat i'esting/Servicing: <br /> F. In-Tank Gauging I SIR Equipment: Check this box if tank gauging is used only for inventory control. <br /> Q Check this box if no tank gauging or SIR equipment is installed. <br /> This section must be completed if in-tank gaugng equipment is used to perform leak detection monitoring. <br /> Ca fete the following checklist: <br /> Yes No* Has an input wiring been inspected for proper mitryand termination including testing forgroundfaults? <br /> Yes + No* Were all tank gaugingprobesvisuellyinspectadfoidemageandresiduebuildup? <br /> Yes Na* Was nccurncyofsystem Product levelreadings tested`e <br /> Yes No* Was accuracy of system water level readings tested? <br /> Yes No* WereallprobesreinstalledproperJV? <br /> Yes Na* Were all items or.the equipment manufacturer's maintenancechecktistcompleted? <br /> •In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> G. Line Leak Detectors (LLD): Check this box ifLLD s are notinstahi ,I. <br /> Co the follow' checklist: <br /> es No* For equipment start-up or annual equipment certification, was a leak simulated to verify L'D performance? <br /> NIA (Check allPharapply) Simulated leak rate: 03g.p.1 t; 0.1 g.p.h.1; 19,0.2g.p.h.2 <br /> Notes: 1. Required for equipment start-up certification and annual certification. <br /> 2. Unless mandated by local agency, certificationrequited only for electronic LLD start_up. <br /> es No* Were allLI.Ds confirmed operational and accurate withinregulataryrequrements? <br /> e No* Was the testing apparatus properly calibrated? <br /> to No* For mechanical LI.Ds, does the LLD restrict product flow ifit detects a leak? <br /> N/A <br /> Yes N For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak! <br /> !A <br /> Yea N * For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is;sabled <br /> /A ordisconnected? <br /> Yes EW For electronic LLDs, does the turbine automatically shut off if anyportion ofthe monitoring system maF=ctior.s <br /> !A or fails a test? <br /> Yes N/A For electronic LLDs,have all accessible witing connections been visually inspected? <br /> es No* Were all items on the equipment manufacturer's maintenance checklist completed? � <br /> _ J <br /> *In the Sectiox H,below,describe how and when these deficiencies wen or wAl be corected. <br /> H. Comments: <br /> Page 3 of 3 03A1 <br />