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Site Address: SS #2186, 3212 N. Calif <br />,tockton <br />Date sting/Servicing: /&'/6-LO__7 <br />F. In -Tank Gauging / SIR Equipment: ❑ Check this box if tank gauging is used only for inventory control. <br />D-�eck 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 />t ....III:..a <br />UO fete me IVlww Ju f, C\111.aa. <br />❑ No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />Yes <br />❑ <br />No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />rYes <br />Yes <br />❑No* <br />Was accuracy of system product level readings tested? <br />Yes <br />❑ <br />No* <br />Was accuracy of system water level readings tested? <br />❑ Yes <br />❑ <br />No* <br />Were all probes reinstalled properly? <br />❑ Yes <br />❑ <br />No* <br />I 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 />G. Line Leak Detectors (LLD): <br />❑ Check this box if LLDs are not installed. <br />t-0 ie <br />es <br />IIIc IVuumII <br />[INo* <br />Duca -0a. <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br />❑ N/A <br />(Check all that apply) Simulated leak rate: �3 g.p.h.'; ❑ 0.1 g.p.h.2; ❑ 0.2 g.p.h.2 <br />Notes: 1. Required for equipment start-up certification and annual certification. <br />2. Unless mandated by local agency, certification required only for electronic LLD start-up. <br />;311Yes <br />❑ No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />es <br />❑ No* <br />Was the testing apparatus properly calibrated? <br />❑ Yes <br />❑ No* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />p�IA <br />es <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />N/A <br />F-1 No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />es <br />❑ N/A <br />or disconnected? <br />Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions <br />❑ N/A <br />or fails a test? <br />es <br />❑ No* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />N/A <br />YesNo* <br />ft[E�] <br />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 />Page 3 of 3 03/01 <br />