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FROM : J.Schetter PHONE NO. : 2097442871 May. 27 2004 09:57AM P4 <br />61 3Z R 2 r D,%e of Tesdr-WSCrviCing: <br />Site Address' �-- <br />F. In -Tank Gauging i SIIt Equipment: Q Cheek ilds box if u-mk paging is usod onlY fbr iuvamory snmrol, <br />❑ Check this box if no tank g„au&g or SIR equipment is insta'.lod. <br />This action must be comp pjeted if in -tank gaining egtzi ew is used to perform leak detection monitanrtg. <br />Coat late the fouDwmA eneexum, for d %UIM7 <br />max C7 No* Hae all iagut v,iring been inspected for prvpr< erubEy and tuon, including ccsdng groan <br />a © Ncr* Were all umk ganging pmbg visually fnsp!d Por damage and resift baildap? <br />es ❑ Ne Was accuraCy of sysb= Tic' level nettings test <br />L� Yes �7 No" Was accuracy of sSvem water Izvel readimp lemed? <br />ce p No" Were all gybes reit Wiwi propedy? <br />Yes ❑ No* Werc all itam on the c 9tZiPment MArraf'actm "'s tna Dt4r* eheckbst corltpl et2Q`' <br />• in the Section -E L, belowo dmribe bow and wben *m ddkiewh!9 wort or will he errreeted. <br />G. jAne Lt9k Detectors (LLD): © Check this box if LLI3s axe nat installed. <br />'L,Qm <br />Q�'Yes <br />a nnc TvjI R �.ucF.uw►• <br />❑ t3o' I For ac�lsmcnt starNuP ar an 1 eggpment certif ation, wo a leak sitbnlated W v� LLD Pet`fUrtttanw <br />� <br />ail that qtly) Simulated leak rale: ; ❑ o, l g,pi C7 a.2 g.p.b."' <br />Li N/A <br />j (Check <br />=t firth ce ort. <br />NObes: 1. Rcquix i for egnip not aatsTt P aErtiflClt{a7t mrd l Cerci <br />br el <br />2. unim mz4ated by ketal agency, Certizrcation 4 fax t 1Cetmpic LLD sutrt-ug. <br />U�-yC5 <br />❑ No" <br />Wcra all LLDs confirmed operational and acrun=,vithin mpUktmv requitem=tsi <br />b�o4ea <br />CI No* <br />' was the testing ap m" ws Pah calibrated? <br />d1KYz <br />C NI)* For n=baaical J UDI, does tb-- LLD restart product flow ff it detects a leak? <br />8 + <br />i �QA <br />p N.aY <br />For eleOWC LLDe_ does the tuy"nc aatomaticably shmt off if tht; LLA &,cotta a lcak7 <br />t� <br />❑ N/A <br />'Yes ❑ -.No* <br />For cicctmm, LLDs, does the titanic aatomadcaily shirt off if anY Portion of the ManitMng 5~'% i6 disabled <br />NlA <br />El No# <br />or dismnected? <br />For alm;ft c LLDs, dims the trlib a auta010cally shut off if any portion of Lbs tn0nAWIk9 SY MM <br />es <br />p N/A <br />maif=ctions or fails a I t?R"I- <br />es <br />C] No" <br />For elccisortic !I&.it>ivc all accesatble wiring eat+aeetions been :asaaLiy tnspxted? <br />ID NIA <br />e9 <br />1D No* <br />were all itoms oa the etluipmettt manuiactutar's tuainte u.e clteclslist :otatpl.eted7 <br />* 1A the 9ecd00 11, below. dttleeihe bow and when dere defieicattiec wcre or will be correctal. <br />ff. Cori meats: <br />Peke 3 of 3 0101 <br />