Laserfiche WebLink
• Site Address �=c lL�V Date of Tesutl�JServicing: �J _ <br /> F. In-Tank Gauging/SIR Equipment: o Check this box if tank gauging is used only for i.nventory control. <br /> Check this box if no tank gauging or SIR exluipiueat is installed. <br /> Phis section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. <br /> �� f;,hr tollo+rin clz♦ecltliut: - <br /> ❑ Yes Cl No* Has all input wiring bvern inspected for proper entry and terminations, including tm"g for ground faults? <br /> C1 Yes ❑ No* Were all Lmk gauging probes visually Uffc ted for dauu'tge and residue buildup? <br /> p Yes ❑ No* Was accuracy of system product Icvel readings toted? <br /> ❑ Yes I ❑ NO Was accuracy of system water Icwet readings iemed? <br /> ❑ Yeti 0 No* Were aU probes reinstalled pMpCrly? <br /> ❑ Yew 1 ❑ No* Were all items on the equipment reran 4t ctorer's maunenw=checklist completed? <br /> to the Section H,below,describe how and wben these defk:meieea ere or will be correrbed. <br /> G. Line Leak Detectors(LLD): Check thus box if LLDS arc:not insurded. <br /> C citertes cbcitk ik <br /> ❑ Yes Q No* For OgUipmrtCnt startwup or annual equipment oertific:ation, was a leak simulated to verify LLD perfor mice? <br /> q N/A (Check all that apply) Simulated leak rate: C)3 g.pA', C1 o-1 g-p.h.'. 0 U.2 9.P.11.2 <br /> Notes: 1. Required for equipment start-up cer(.ifiw-tion iqW aminal=UftcaUon. <br /> 2. Unless numdated by local agency,certification required only for electronic LLD dart-up. <br /> 0 Yes 0 No* Were all LLDs confirmed operational and accurate witlwi regulatory requirements? <br /> C7 Yes 0 No* Was this testing apparatus properly calibrated? <br /> CI Yes ❑ No* For mcchanicW LLDs,docs the LLD restrict product flow if it defects a leak'? <br /> ❑ N/A <br /> ❑ Yes ❑ No* For electronic LLDs,does the tine automatically shut off if the LLD detects a leak? <br /> []tN/AA <br /> ❑ Yes C) For electronic I I..Ds,does the turbine m4o►natic ally shut oil'if any portion of the monitoring SystCur i$disabled <br /> ❑ or disconnected? <br /> D Yes Q No* For electronic LLM does the turbine automatically shut off if any portion of the nwailoriag system <br /> ❑ N/A rualfiu dons or fails u test? <br /> p Yes ❑ No* For electronic LLDs,have all acc=hle wiring coiniections been visually inspected? <br /> ❑ N/A <br /> ❑ Yes ❑ No* Were all items on Ute equipment mam facturef's maintenance clwck1W completodl <br /> to the Section H,below,describe brow aad when these derrcieucies were or will be corrected. <br /> H. Comments: <br /> PYA 3 or <br /> L0/b0 3OVd ONIlS31 NOIdWhHO VLVL69ET99 TS:ST 900Z/GT/90 <br />