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F. In -Tank Gauging / SIR Equipment: ❑ Check this box if tank gauging is used only for inventory control. <br />❑ Check this box if no tank gauging orSMequipment is installed. <br />This section must be completed if in -tank gauging equipment is used to perf . eak detection monitoring. <br />l.,ro..lo+a +hn fnllnwina rherklict' <br />❑ Yesv`v <br />❑ vNo*- <br />Has all input wiring been inspected for proper a and termination, including testing for ground faults? <br />❑ Yes <br />❑ No* <br />Were all tank gauging probes visually inspec ed for damage and residue buildup? <br />❑ Yes <br />❑ No* <br />Was accuracy of system product leyerreadings tested? <br />❑ Yes <br />❑ No* <br />Was accuracy of system waXer°level readings tested? <br />❑ Yes <br />[� <br />❑ No* <br />Were all probes reintafed properly? <br />❑ Yes <br />❑ No* <br />I Were all item"ri the equipment manufacturer's maintenance checklist completed? <br />* In the Section H, below,Aegc ribe how and when these deficiencies were or will be corrected. <br />G. Line L a Dee ctors (LLD): ❑ Check this box if LLDs are not installed. <br />Complete the following checklist: <br />Yes <br />❑ No* <br />For equipment start-up or annual equipment 2rtification, was a leak simulated to verify LLD performance? <br />El N/A <br />(Check all that apply) Simulated leak rate: 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 />79 Yes <br />❑ No* <br />Was the testing apparatus properly calibrated? <br />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 />❑ 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 />❑ 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 />❑ N/A <br />malfunctions or fails a test? <br />❑ Yes <br />❑ No <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />❑ N/A <br />y Yes <br />El No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />* In the Section H. <br />below. describe how and when these deficiencies were or will be corrected. <br />H. Comments: <br />Testing Company Name: TANK- TEK ENVIRONMENTAL <br />Site Address: 109L12 S. HO_rlcsln 4 . <br />Phone No.: (707) 446-6151 <br />Date of Testing/Servicing: to t`7 / n5 <br />Page 3 of 3 03/01 <br />