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Bite Addraas: <br /> 21163-.290%ggN1AMIN E[OLT DR,STCICKTON,CA 95207 Date,of Tei, aryl _ Z. d <br /> F. In-Tank Gauging J SIR Equipment: oAthis box if tank gauging is used only for inventory control. <br /> Check 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 /> Com late the fallow ehec t: <br /> Yes No* Has all input been inspected for proper entsyandteuMnation,including testing for ground faults? <br /> Yes No* Were all gauging probes visually inspected for damage and residue buildup? <br /> Yes No* Was accuracy of sy product level readings tested? <br /> Yes No* Was accuracy of system w level readings tested? <br /> Yes No* Were all probes reinstalled prop <br /> Yas No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> *In the Section Ii,below,describe how and when tkese de were or wimuire corrected. <br /> G. Line Leak Detectors (LLD): t5 Check this box if LLDs are not installed. <br /> Complete the fellowin ehee ' t: <br /> Yes No* For equipment start-up or annual equipment ceMcatior.6 was a leak simulated to verify LLD performance? <br /> Q NIA (Check all that.appty) Simulated leak rate: Of3 g.p h.1; [a 0.1 g.p.0; 0.2 g.p.0 <br /> Notes: 1. Required for equipment startup certification AUd annual certification. <br /> 2. Unless mandated by local agency, certification required only for electronic LLD startup. <br /> Yas No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> Yes No* Was the testing apparatus properly cah"brated? <br /> Yes No* For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> NIA <br /> Yes 0' No* For electronic LLDs,does the turbine automatically shut off if the LLD detects aleak? <br /> NIA <br /> Yes P No* 1 For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br /> Ej N/A I or disconnected? <br /> Yes No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system m ctions <br /> N/A or fails a test? <br /> Yes _ No* For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> NIA <br /> as No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> *In the Section II,below,describe kow and when these deficiencies were or will be correct¢d. <br /> H. Comments: <br /> Page 3 of 93A1 <br />