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u.l"to '.triil k,er Iif lCa tion <br />Facility Name: Norm's 76 <br />F. In -Tani. Gauging Equipment: <br />u.ttc of icsung,�>ctVictng: 7 /1 3 / 00 <br />Check this box if tank gauging is used only for inventory connol. <br />This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. <br />Software Version Installed: 250-20-2 Rev 01 —1 1 <br />ComnlPtP the fnllawino Phor4lict- <br />® Yes <br />❑ <br />No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />0 Yes <br />❑ <br />No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />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 />RI Yes <br />❑ <br />No* <br />Were all alarms activated and did they function properly? <br />M Yes <br />❑ <br />No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />......, --lull Z1, ueiuw, uescrme nuw anu wnerl (nese QeItctenctes were or will be corrected. <br />G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. <br />Complete the following checklist: <br />® Yes <br />❑ No* <br />Was a leak simulated to verify LLD performance? (Check all that apply) <br />Simulated leak rate: M 3 g.p.h.; ❑ 0.1 g.p.h.; ❑ 0.2 g.p.h. <br />Yes <br />❑ No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />Yes <br />❑ No* <br />Was the testing apparatus properly calibrated? <br />1 Yes <br />0 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 />7&] 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 />M 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 />M Yes <br />❑ No* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />❑ N/A <br />A Yes <br />❑ No* i <br />If necessary to proper equipment operation, are fuel filters in good condition? <br />Yes <br />❑ No* <br />Were all items on the equipment manufacturer's maintenance checklist completed'? <br />to the Jection H, below, describe how and when these deficiencies were or will be corrected. <br />H. Comments: <br />Nage 3 06/2 m9 <br />