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02/09/2010 11:30 FAX 916 371 2380 BZ SERVICE STATION 10 004 <br /> F. In-Tank Gauging/SIR Equipments ❑ Check this box if tank gauging is used only for inventory control. <br /> ❑ Check this box if no tank gauging or Slit equipment is installed. <br /> This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. <br /> Complete the following checklist: <br /> x Yes ❑ No* Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> x Yes ❑ No* Wme all lank gauging probe visually inspected for damage and residue buildup? <br /> x Yes ❑ No* Was accuracy of system product level readings tcstei? <br /> x Yes Cl No* Was accuracy of system water level readings tested? <br /> x Yes ❑ No* Were all probe reinstalled properly? <br /> x Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> *In the Section H,below,describe how and when these deficiencies were or will be corrected, <br /> G. Line Leak Detectors (LLD): ❑ Chock this box if LLDs are not installed. <br /> Com Tete the fo Ing checklist: <br /> x Yes ❑ No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br /> Cl N/A (Check all that apply) Simulated leak rate: x 3 g.p.b,, ❑0.1 g.p.h; ❑ 0.2 g.p.h. <br /> x Yes ❑ No* Wcrc all LLDs confirmed operational and accurate within regulatory requirements? <br /> x Yes ❑ No* Was the testing apparatus properly calibrated? <br /> x Ycs ❑ No* For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> ❑ N/A <br /> ❑ Yes ❑ No* For electronic LT.1-13,docs the turbine automatically shut off if the LLD detects a leak? <br /> x N/A <br /> ❑ Yes ❑ No* For electronic LLDs,duos the turbine automatically shut off if any portion of the monitoring system is disabled <br /> x N/A or disconnected? <br /> C3 Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system <br /> x N/A malfunctions or fails a lest? <br /> ❑ Yes ❑ No* For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> Ix N/A <br /> x Yes ❑ No* Were all items on the:equipment manufacturer's maintenance checklist completed? <br /> *In the Section JET,below,describe how and when these deficiencies were or will he corrected. <br /> H. Comments: <br /> UN-036—1/4 wWwaniidoc®.org Rev.at/E6/06 <br />