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4 "J"'Tiol Illy ay "Icnl k ei nucatton <br />Facility Name: - -- Norms 76 _—_-___—_--- gale of i csung,.-rvicung: 6 <br />F. In -Tank Gauging Equipment: ❑ Check this box if tank gauging is used only for inventory connoi. <br />This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. <br />Software Version Installed: 01-11 <br />Comnlete the fnllawinv chPekiict- <br />® Yes <br />I ❑ <br />No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />M Yes <br />❑ <br />No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />0 Yes <br />❑ <br />No* <br />Was accuracy of system product/waste level readings tested? <br />® Yes <br />❑ <br />No* <br />Was accuracy of system water level readings tested? <br />® Yes <br />❑ <br />No* <br />Were all alarms activated and did they function properly? <br />® Yes <br />❑ <br />No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />......< «„v„ u, uceuw, urxnuC llUw allu wilen [[lose uenctencles were or will be corrected. <br />G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. <br />Complete the following checklict- <br />M Yes <br />❑ No* <br />Was a leak simulated to verify LLI� performance? (Check all that apply <br />Simulated Leak rate: � 3 g.p.h.; ❑ 0.1 g_p.h.; ❑ 02 g.p.h. � <br />® Yes <br />❑ No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />0 Yes <br />If No* <br />Was the testing apparatus properly calibrated? <br />0 Yes <br />❑ No* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />❑ N/A <br />❑ Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />M N/A <br />❑ Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />0- N/A <br />or disconnected? <br />❑ Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring . system <br />M N/A <br />malfunctions or fails a test? <br />Cl Yes <br />❑ No* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />l N/A <br />M Yes <br />❑ No* I <br />If necessary to proper equipment operation, are fuel filters in good condition? <br />❑ N/A <br />fX7 Yes <br />❑ No* I <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />to the Section H, below, describe how and when these deficiencies were or will be corrected. <br />H. Comments: <br />CALM -01 Nage 3 0623/99 <br />