COMPLIANCE INFO_2001-2009 - Laserfiche WebLink

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Monitoring System Certification Site Address: F. Iii -Tank Gauging/ SIR Equipment: P. 03 4DRAFT Date of Testing/Servicing: ❑ Check this box if tank gauging is used only for inventory con :rol. ❑ Check this box if 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 folio lag checklist: ❑ Yes O No* I Has all input wiring been imp -d-Yes ❑ No* Were all tank gauging probes, d Yes O No* Was accuracy of system produ 7 :Yes O No* Was accuracy of system water ❑ Yes O No* Were all probes reinstall, O Yes O No" I Were all items on the eq, " in the sectfart II, below, describe how and G. Line Leak Detectors (LLD): proper entry and termination, including testing for �t manufacturer's Maintenance checklist comp these deficiencies were or will be corrected, ❑ Check this box if LLDs are not installed. Complete the follo lug checklist: Yes ❑ No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD pe D NIA (Check all that apply) Simulated leak rate: e3 g.p.h.'; O o.l g.p.h.=; U 0 h .2 g.p_.' Notes: 1. Required for equipment start-up ecrtification And annual certification. 2. Unless mandated by local agency, certification required only for electronic LLD start-up. Yes Q No* Were all LLDs confirmed operational and accurate within regulatory requirements177" Yes O No* Was the testing apparatus properly ..Yes ❑ No*: For mechanical LLD,, does the LL * In the Section H, belt H. Comments: describe how and when LIuucr uow it it amects a leav :ally shut off if the LLD detects a 1� Bally shut off if any portion of the matically shut off if any portioi connections been visually inspectee maintenance checklist compacted? were or will be corrected. monitoring system of the nronitonng system CALm-as Page 3 90 11/15197; O Yes. O No* For electronic LLDs, docs the turbi A N/A O Yes Q No* For electronic LLDs, does the Curb. QUA or disconnected? No* For electronic LLDs, does the t 1V /A mlfanctions or fails a test? E❑ O NO«� For electronic LLDs, have all accI'NoCIWere ell items on the equipmcnr mt * In the Section H, belt H. Comments: describe how and when LIuucr uow it it amects a leav :ally shut off if the LLD detects a 1� Bally shut off if any portion of the matically shut off if any portioi connections been visually inspectee maintenance checklist compacted? were or will be corrected. monitoring system of the nronitonng system CALm-as Page 3 90 11/15197;