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--'-CBVED ri E Facility Name: Costco # 1031 Manteca (Page 3) In-Tank Gauging: AUG 3 0 Z018 ®Check this box if tank gauging is used only for inventory control. ENVIRONMENTAL HEALTH DEPARTMENT Complete the following checklist: F-1 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? El Yes ❑ No* Were all probes reinstalled properly? E]Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the 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 and disregard the following section. ®Yes ❑ No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD ❑ N/A performance? (Check a// that app/y) Simulated leak rate: ® 3 gph.; ❑ 0.1 gph ; ❑ 0.2 h. ®Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? ®Yes ❑ No* Was the testing apparatus properly calibrated? ®Yes ❑ No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ❑ N/A ®Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ❑ N/A ®Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system ❑ N/A is disabled or disconnected? ®Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system ❑ N/A malfunctions or fails a test? ®Yes F1 No* For electronic LLDs, have all accessible wiring connections been visually inspected? ElN/A ®Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. H. Comments: