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01/02!1995 03:27 2697546722 CALAVERAS ENV HEALTH <br />tia0te� tlg System Certiflesdon <br />Facility Name. LA7 .i iec of 1 Cauug,J.I� ).wg: I/_ <br />F. In -Tank Gauging Equipment: <br />Q Cluck this box if unk gauging is used only for inventory control. <br />This section mast be completedq if in -tank gauging equipment is used to perform )eak detection monitoring. <br />Software Version bmallcd-- <br />Complete the win checklist: <br />Yes Q No* Has all ' wiring been inspected for proper entry and termination including testing for ground faults? <br />cs Q No® Were alt gauging probes visually reel for ge and residue Z;ss:ld;.gs'r <br />es Q No* Was accuracy of system product/waste level readings tested? <br />Yes C1 NO* Was attorney of system water level readings tested? <br />Yes ❑ No" Were all alums activated and did they function properly? <br />Yes Cl Ne Were all iterrns oct the equipment manufacturer's maimtcnnnce checklist completed? <br />In the Section $ below, describe how and when these deficiencies were or wit) be correcte& <br />G. Lute Leek Detectors (LLD): <br />f'etnniete the fallowin: ehetkileRs <br />Q Check this box if LLDs are not installed. <br />Yu <br />Cl No• <br />Was a leak simulated to verify LLD ptxfotarance? (check all that apply) <br />Sirnulated kak rate: 3 g.p_h-; 0 0.1 &-p-h.; O 01 g -p -h - <br />Yes <br />Q No- <br />Were all LLD. confirmed operational and accurate within regulatory requirements? <br />- d <br />ti Yes <br />® No• <br />Was the testing apparatus properly athbnted? <br />es <br />D No' <br />For mechanical LLDs, docs the LLD restrict product flow if it detects a leak? <br />O NIA <br />❑ Yes <br />0 No* <br />For electronic LLDs, docs the turbine automatically shut off if the LLD detects a kak? <br />WA <br />O Yes <br />O No` <br />For eiccuonic LLDs, does the Wahine automatically shut off if any portion of the monitoring system is disabled <br />•.TI -N/A <br />or disconnected? <br />❑ Yes <br />® No• <br />For electronic 11 , docs the turbine automatically shut off if any portion of the monitoring system <br />N/A <br />atalfivrictions or furls a test? <br />❑ Yes <br />a No' <br />For electronic LLDs, have all accessible wiring connections been visually taspected? <br />11 <br />N/A <br />Ycs <br />® No' <br />If necessary to proper equipment operation, are furl filters in good condition_' <br />0 WA <br />Yes ❑ No' <br />I Were all items on the equipment manufacturer's maintettanee checklist completed?. <br />In the Section H. <br />below. describe how and when these deficiencies were or will be earrected. <br />A. Comments: <br />CALK -81 Page 3 <br />