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' UNDERGROL ORAGE TANK MONITORING SYSTEORTIFIC ATIOltiT <br /> F. In-Tank Gauging/ SIR Equipment: Permit Number: <br /> ❑ Check this box if tank gauging is used only for.inventory control <br /> ❑ Check this box if no tanh eauginy1of'S1R equipment is installed <br /> This section must be completed if in-t ` ' gauginor e uTent is used to perform leak detection <br /> monitoring <br /> �. <br /> Complete the followinL, checklist: <br /> ❑ Yes I ❑ No* Has all input wiring been Inspected for proper entry-and termination,including testing for ground faults? <br /> ❑ Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> ❑ Yes Z1No* Was accuracy of system product`level readings tested? <br /> ❑ Yes ❑ No* Was accuracy of system water level''ead_ings tested" <br /> ❑ Yes ❑ No* Were all probes reinstalled properly? <br /> ❑ Yes ❑ No* I Were all items on the equipment manufacturer'sinaintenance checklist completed? <br /> In Section H below, describe how and when these deficiencies were or,,,will be corrected. <br /> G. Dine Leak Detectors rl✓x,D): ❑ Check this box if LLDs are no installed. <br /> Complete the following checklist: <br /> ❑ Yes I ❑ No* For equipment start-up or annual equipment certifmcatioy, was a leak simulated to verify LLD performance? <br /> ❑ NIA (Check all that apply) Simulated leak rate: ❑ 3 g.p.l &] 0.1 g.p.h. ; ❑ 0.2 g.p.h. <br /> ❑ Yes ❑ No* Were all LLDs confirmed operational and accuraty'within regulatory requirements? <br /> ❑ Yes ❑ No* Was the testing apparatus properly calibrated <br /> ❑ Yes ❑ No* For mechanical LLDs, does the LLD res ' t product flow if it detects a leak? <br /> ❑ NIA <br /> ❑ Yes ❑ No* For electronic LLDs,does the turbine `utomatically shut off if the LLD detects a leak? <br /> ❑ NIA ! <br /> ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br /> ❑ N/A or disconnected? <br /> ❑ Yes ❑ No* For electronic LLDs, noes the turbine iutomatically shut off if any pordon of the monitoring system malfunctions <br /> ❑ NIA or fails a test? <br /> ❑ Yes ❑ No* For electronic LLDs,have all accessible�w=— g connections been visually.inspected? <br /> ❑ NIA <br /> ❑ Yes I❑ No* 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 /> 'j <br /> 1 <br /> DEH:HM-9301,(Rev 08/02)..,. Page 3 of 4 County of San Diego-DEH-Hazardous Materials Division <br />