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Site Address: w�� !] K/Ar i U of Lw' .. L 4 Dat!of Testing/Scrvlc F In-Tank Ganging/SIR Egaipsaent., /�17Check this box if tmttk us Pug"S is ed only for Inventory control_ d C71eck tltis box if no tattle gaugirtg ur SIR equipment is installed '1 WS sect;on must be completed if in-tank gauging equipment is used to perform leak detection mortitohn . Completer the following cbeekum Yes 0 Ne Has all input W"hiu8 been inspected for WOW entry and wminati 17 Yes No* Were all tank ort•txxcludtttg testing for ground faults� 8au P +atsualiy irtspmmm for dsu agy and residue buildup. d Yea Na' Was aecuracq of systeM product level reaaMgS tested? Yrs No* Was accuracy of system waren Level resdirggs tested? Yes D Na• Were all probes reinstalled Pmperjy? 0 Yrs Were all items uu the equipment tt&MXaexures's rs;alttteaance clxecklist completed? 111 the S&ctien H,Wt w,deserlbe bOw anti wtwn those deltlr3eaCies weWv or Will be Carrecxed. G. Line Leak Detectors (LLD): ® Check this box if LLDs are not instahed. CGmPle to the fallowing checklist: Yes Q No* For equipment startup or annual egUiPrrtettt certiftc,.tiort, was a leak simulated D to verify LLD performance2 141A (Check all that apply) Sileak rate:X3 B P h�, ❑O.I s.P�x; ❑0,2 g.P.h_Z Notes: 1. Required for equipment start-up ecrtificad n Wd urqual certificarion 2. Unless mandated by kfal agency,certification required only for elec!-oric LLD start-up. Yes Q No* Wexe all LL i eonflaued apetatior]and acute within regulatory requirements" Yes J` Ivo* Was the tostitlg apparatus properly calibrated? Yes DNo* Far mechawcal LLU-,,,dues the LLD restrict product flow if it Meets a leak? C1 NIA Cl Yes U No* For electronic LLD-,docs lire turbine autcrrrtatitalllyshut otPifthe LLD detects a lesk'r NIA Yta l3 No* For eteoctmnic LLDs,does the turbltSe automa&Any shutoff if any portion of the monitoring system NIA Ordiscormecteeia s is disablr~d U Yes 0 No* For electronic LLD., does the turbine autoruatically shut off if any portiern of the niartitoring system NIA malfltnctions or fails a trot? ►Z1 Yes D No* For electronic LLD.,;have all accessible wiring taanre£ctioas been visual[ NIA Y lnspec ted? Yes J tr"o;1 Were all items on the equipment manufacturer's maintauunce checklist corautcted? In the Section H,below,describe ho wand when these dcf bene es fere or will be corrected. H. Comnsents:AS r I ICJJ o 5 CALM-41 Page 3 of : t vts►�;