COMPLIANCE INFO_2007-2015 - Laserfiche WebLink

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tom_ J Site Address: F. In -Tank Gauging / SIR Equipment: Date of Testing/Servicing: ❑ Check this box if tank gauging is used only for inventory control. ❑ 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. Com fete the followiag checkffst: es ❑ No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? es ❑ No* Was accuracy of system product level readings tested? Yes [3No* Was accuracy of system water level readings tested? [2''Y,es I ❑ No* I Were all probes reinstalled properly? Yes 1 ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed, f'emuletr the fnlinwino rharrrHat- Gryes ❑ No* For equipment start-up or annual equipmen�t ce� cation, was a leak simulated to verify LLD performance? ❑ N/A (Check all that apply) Simulated leak rate: C't"3 g.p.h.'; ❑ 0.1 g.p.h.2; ❑ 0.2 g.p.h.2 Notes: 1. Required for equipment start-up certification and annual certification. 2. Unless mandated by local agency, certification required only for electronic LLD start-up. ❑ Yes No* Were all LLDs confirmed operational and accurate within regulatory requirements? MOY Yes ❑ No* Was the testing apparatus property calibrated? !3 Ves ❑ No* For mechanical LLDs, does the LLD restrict product flaw if it detects a leak? ❑ N/A ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ff N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled ❑ Yes I9"NIA ❑ No* or disconnected? ❑ Yes ❑,No* d N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? For electronic LLDs, have all accessible wiring connections been visually inspected? ❑ Yes ❑ No* p'N/A t3 Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section E, below. dewribe ham tanrl ®1 — +;.__ a .* ___--'-- H. Comments:r t. Z2 � -+.,.e.... — c vi w ii[ De currecrem Page 3 -of 3 03/01