COMPLIANCE INFO_1987 - 2005 - Laserfiche WebLink

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Site Address Date of Testing/Servicing: j F. (n-'rank Gauging/SIR Equipment: C3,5beck this box if tank gauging is used oniv for►mentory control. ET Check this box if no tank gauging or SIR equipment is insallled. This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. Complete the ioilewio&checklist: ❑ Yes ❑ No* Has all input wiring been inspected for proper entry and termination. including testing for ground faults? ❑ Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? ❑ Yes ❑ No* Was accuracy of system product level readings tested? ❑ Yes ❑ No* Was accuracy of system water level readings tested? ❑ Yes ❑ No* Were all probes reinstalled properly'? ❑ Yes ❑ No* j Were all items on the equipment manufacturer's maintenance cfux*I st completed? In the Section H,below,describe how and when these deficZChcck"tmhis or will be corrected. G. Line Leak Detectors (LLD): box if LLDs are not installed. Complete the ing check isL ❑ Yes ❑ No* For equipment start-up or annual equipment certification. was a leak simulated to verify LLD performance'' ❑ N/A (Check all that apply) Simulated leak rate: ❑ 3 g p.h.'-, ❑0.1 g.p.h 2-, ❑ 0.2 g.p.h.` Notes: l. Required for equipment start-up certification and annual certification. 2. Unless mandated by local agency, certification required only for electronic LLD start-up. ❑ Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? ❑ Yes ❑ No* Was the testing apparatus property calibrated? ❑ Yrs 'J' No* For mechanical LLDs,does the LLD restrict product flow if it detects a leak? ❑ N/A n Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ❑ N/A ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if am portion of the monitoring system is disabled ❑ N/A or disconnected? ❑ Yes ❑ No* For electronic LLD& does the turbine automatically shut off if any portion of the monitoring system ❑ N/A malfunctions or fails a test'? ❑ Yes ❑ No* For electronic LLDs, have ail accessible wiring connections been yrtsually inspected:' ❑ N/A ❑ Yes ❑ No* Were all items on the equipment manufacturers maintenance checklist completed? ' In the Section H,below,describe how and when these deficiencies were or will be corrected. H. Comments: Page 3 of 3 03101