COMPLIANCE INFO_2004-2007 - Laserfiche WebLink

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Monitoring System Certification Site Address: 2375 WEST GRANT LINE ROAD F. In -Tank Gauging /SIR Equipment Date of Testing/Service: 07/26/2007 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. Complete the following checklist: ❑ Yes ❑No' Has all input wiring been inspected for proper entry and termination, inGuding testing for ground faults? ❑Yes ❑ No' Were all tank gauging probes visually inspected for damage and residue buildup? ❑Yes ❑ No * Was accuracy of system product level readings tested? ❑Yes ❑No * Was accuracy of system water level readings tested? Yes ❑ No * Were all probes reinstalled properly? Yes ❑ No * Were all items on the equipment manufacturers' maintenance checklist completed? " In the Section N, below, describe now aha when these oetic�encies were or wm oe con'ectea. G. Line Leak Detectors (LLD) : ❑ Check this box if LLDs are not installed. Complete the following checklist: ❑ Yes ❑ No * X ❑N/A For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? Check all that apply) Simulated leak rate: ❑ 3 g.p.h ❑ 0.1 g.p.h ❑0.2 g.p.h Yes ❑ No * Were all LLDs confirmed operational and accurate within regulatory requirements? Yes ❑ No * Was the testing apparatus properly calibrated? ❑Yes ❑ No ` � N/A For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ❑Yes ❑No ` ❑X N/A For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ❑Yes ❑No * � N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? ❑ Yes ❑No * Q N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? ❑Yes ❑No' Q N/A For electronic LLDs, have all accessible wiring connections been visually inspected? Yes ❑No' Were all items on the equipment manufacturers' maintenance checklist completed? * In the Section H, below, describe how and when these denciencies were or wul be correctea. Page 3 of 3 Based on CA form dated 03/01