COMPLIANCE INFO_2013-2018 - Laserfiche WebLink

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F. In -Tank Gauging / SIR Equipment: ® Check this box if tank gauging is used only for inventory control. ❑ Check this box 9 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. Complete the following checklist: ❑ Yes ❑ No* Has all input wiring been Inspected for proper entry and termination, including testing for ground fauits? ❑ NIA ❑ Yes ❑ No' Were all tank gauging probes visually inspected far damage and residua buildup? a "" � Was the testing apparatus properly calibrated? ❑ Yes ❑ No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ❑ NIA ❑ Yes ❑ No* Was accuracy of system product level readings tested? ❑ N/A ❑ Yes ❑ No* Was accuracy of system water level readings tested? ❑ N/A ❑ Yes ❑ No*Were all probes reinstalled properly? _.. _ a7 ❑ Yes ❑ No' I Were all items on the equipment manufacturer's maintenance checklist completed? ❑ N/A ' In Section H, below, describe how and when these deficiencies were or will be corrected. ❑ Yes ❑ No* Line Leak Detectors (LLD): ® Check this box If LLDs are not installed. ❑ Yes ❑ No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check ad that apply) ❑ NIA Simulated leak rate: ❑ 3 g.p.h.; ❑ 0.1 g.p.h; [10.2 g.p.h. ❑ Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? ❑ Yes ❑ No* Was the testing apparatus properly calibrated? ❑ Yes ❑ No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ❑ NIA ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ❑ N/A ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off If any portion of the monitoring system is disabled or disconnected? ❑ N/A ❑ Yes ❑ No' For electronic LLDs, does the turbine automatically shut off If any portion of the monitoring system malfunctions or falls a test? ❑ NIA ❑ Yes ❑ No* For electronic LLDs, have all accessible wiring connections been visually inspected? ❑ N/A ❑ Yes ❑ No* Were all items on the equipment manufacturees maintenance checklist completed? * In Section H, below, describe how and when these deficiencies were or will be corrected. H. Comments: LINE TEST DONE GENERATOR FOR HOSPITAL — NO LD Monitoring System Certification Page 3 of 4 2/21/07 I