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04/16/2003 16:13 4089 t- SSS INC PAGE 04 <br />so ft <br />Monitoring System ('edification - Page 3 of 3 <br />Site .Address: 2575 Country Club Blvd. @ Plymouth <br />Date of Testing/Servicing: 03119/03 <br />F. In -T ank Gauging / SYR Equipinent: no Check this box if tank gauging is used only for inventory control, <br />❑ Check this box if no tank gauging or SIR cquipment is iitstulled, <br />This section [oust be completed if in -tank gauging equipment is used to perform. leak detection monitoring. <br />I. VLII JKI.c uac avacv r•aaa raavw•�••..•• <br />❑Yes <br />* In Section H below, describe how and when these deficiencies were or will ne corrected. <br />G. 11ne beak Detectors (LLD): ® Check this box if LLD's are not installed. <br />a.vua eeac <br />® Yes <br />[],No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faa.Its! <br />❑ Yes <br />0 No* <br />Wcre all tank gauging probes visually inspected for damage and residue buildup'? <br />0 Yes <br />0 No* <br />Was accuracy of system product level readings tested! <br />0 Yes <br />❑ No* <br />Was accuracy of system. water level readings tested'? <br />❑Yes <br />❑ No* <br />Were all probes reinstalled properly'? <br />0 Yes <br />❑ No* <br />'Fere all, items on the equipment manufacturer's maintenance checklist completed.? <br />* In Section H below, describe how and when these deficiencies were or will ne corrected. <br />G. 11ne beak Detectors (LLD): ® Check this box if LLD's are not installed. <br />a.vua eeac <br />® Yes <br />aaae a•/••Y ••••• <br />❑ No* <br />For equipment start-up or annual equipment certification was a leak simulated to verify LLD perforRrta.nvC? <br />❑ N/A <br />(Check all that apl7ly) Simulated leak reate: 10 3 g.p.h. (I.); ❑ 0.1 g,p.h. (2.); 0 0.2 -,p.h. (2). <br />Notes 'I Regliire(i for equipment start-up certification and annual certification_ <br />2. Unless mandated by local agency, certification required only for electronic LLD start-up. <br />0 Yes <br />❑ No* <br />Were all LLD's confirmed operational and accurate within re ulatory requirements? <br />0 Yes <br />0 No,' <br />Was the testin apparatus properly calibrated? <br />0 Yes <br />❑ No* <br />For mechanical LLD's, does the LLD restrict product flow if it detects a leak? <br />3 NIA <br />® Yes <br />❑ No* <br />For electronic LLD's, does the turbine automatically shut off if the LLD detects a leak'? <br />U N/A <br />For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />z Yes <br />❑ No's <br />El N/A <br />or disconnected'? <br />to Yes <br />u No* <br />For electronic LLD's, does the turbine automatically slum off if any puw, tiuil ur tlic 111011itoring system. <br />0 NIA <br />malfunctions or fails a test? <br />® Yes <br />n No* <br />Pnr electronic LLD's, have all accessible wiring connections been visually inspected? <br />❑ NIA <br />Yes <br />❑ No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />* In Section .H. below, describe how and when these deficiencies were or will be corrected. <br />H. Comments: <br />