COMPLIANCE INFO_2009-2011 - Laserfiche WebLink

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C r- 6_1 6_ UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION F. In -Tank Gauging / SIR Equipment: ® 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 fnllnwina checklist! ❑ Yes ❑ 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? ❑ Yes ❑ No* Was accuracy of system product level readings tested? ❑ Yes ❑ No* Was accuracy of system water level readings tested? ❑ Yes I ❑ No* Were all probes reinstalled properly? ❑ Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? * In 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. Com fete the foll *ng checklist: * In Section H below, describe how and when these deficiencies were or will be corrected. H. Comments: T5 -Premium Line Leak Detector Failed, replaced, retested and passed. Page 3 of 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* ❑ N/A ® 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* ® 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* ❑ 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* ® N/A For electronic LLDs, have all accessible wiring connections been visually inspected? ® Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? * In Section H below, describe how and when these deficiencies were or will be corrected. H. Comments: T5 -Premium Line Leak Detector Failed, replaced, retested and passed. Page 3 of