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Site Address: SS#6080, 85 E Louise Avenue,Lathrop Date of .esting/Servicing: )q-03 F. In-Tank Gauging / SIR Equipment: ❑ Check this box if tank gauging is used only for inventory control. jr-C—heck this box if no tank gauging or SIR equipment is installed. This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. Com lete the o o ing checklist: V ❑ No* Has all input wiring been inspected for proper entry and termination,including testing for ground faults? ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? ❑ No* Was accuracy of system product level readings tested? ❑ No* Was accuracy of system water level readings tested? ❑ Yes ❑ No* Were all probes reinstalled properly? ❑ Yes O No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H,below,describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. COm tete the o ing checklist: Yes ElNo* 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: BT-g—p.h.1; ❑ 0.1 g.p.h.2; ❑0.2 g.p.h.2 Notes: 1. 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 properly calibrated? C;� I'es ❑ No* For mechanical LLDs,does the LLD restrict product now if it detects a leak? ❑ N/A ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ❑- to ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled [�N/A or disconnected? ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions p--N/A or fails a test? ❑ Yes ❑ No* For electronic LLDs,have all accessible wiring connections been visually inspected? 2--5/-A Yes El No* Were all items on the equipment manufacturer's 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 03/01