COMPLIANCE INFO 2002-2010 - Laserfiche WebLink

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Nlor,Ocring System Certit7calion ite Address:/ 1 Date of"T'esting/Servicing: .Z 11TH I Q In-Tank Gauging/SIR Equipment: ❑ Cl this box if tank gauging g ming 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 equipn tis used to perform leak detection monitoring. Complete the following checklist: 12 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? U 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? Q 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): El Check this box if LLDs are not installed. Com a the following checklist: Yes ❑ No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? ❑ N/A (Check all that apply) Simulated leak rate: f 3 g.p.h.; ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? Ye ❑ No* Was the testing apparatus properly calibrated? Wo"Vies ❑ 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? 21"IC/A ❑ Yes ❑ * For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled N/A or disconnected? ❑ Yes ❑ Na* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system N/A malfunctions or fails a test? ❑ Yes El * For electronic LLDs, have all accessible wiring connections been visually inspected? Cdr N/A Yes ❑ No* Were all items on (fie equipment manufacturer's maintenance checklist completed? * In the Section H,below,describe how and when these deficiencies were or will be corrected. H. Comments: