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11 <br />F. In -Tank Gauging / SIR Equipment: <br />❑ Check this 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 pe-�rforrrlek detection monitoring. <br />Comnlete the following checklist: / <br />❑ Yes <br />❑ No* <br />Has all input wiring been inspected for proper en d termination, including testing for ground faults? <br />❑ Yes <br />❑ No* <br />Were all tank gauging probes visually i d for damage and residue buildup? <br />❑ Yes <br />❑ No* <br />Was accuracy of system product levoifadings tested? <br />❑ Yes <br />Cl No* <br />Was accuracy of system watLpKel readings tested? <br />❑ Yes <br />❑ No* <br />Were all probes reinstal properly? <br />❑ Yes <br />❑ No* <br />Were all items on a equipment manufacturer's maintenance checklist completed? <br />* In the Section H, below, dese ' e how and when these deficiencies were or will be corrected. <br />G. Line Leak Detect rs (LLD): ❑ Check this box if LLDs are not installed. <br />Complete the following checklist: <br />es <br />❑ No* <br />❑ N/A <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br />(Check all that apply) Simulated leak rate:.p.h.; ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. <br />s <br />❑ No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />Yes <br />❑ N <br />Was the testing apparatus properly calibrated? <br />❑ Yes <br />No* <br />❑ N/A <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />❑ Yes <br />❑ No* <br />❑ N/A <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />❑ Yes <br />❑ No* <br />❑ N/A <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />or disconnected? <br />❑ Yes <br />❑ No* <br />❑1. N/A <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system <br />malfunctions or fails a test? <br />❑ Ye <br />❑ No <br />El N/A <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />' Yes <br />❑ No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />* In the Section H. <br />below. describe how and when these deficiencies were nr will he rnrrPrtPdi <br />H. Comments: <br />Testing Company Name: <br />Site Address: <br />-TEK ENVIRONMENTAL <br />Phone No.: (707) 446-6151 <br />Date of Testing/Servicing: l®/25E6, <br />Page 3 of 3' 03/01 <br />