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• 3 � S 153 <br /> Site Address: SS#6335,4855 South State Route 99,Stockton Date of <br /> F. In-Tank Gauging/ SIR Equipment: ❑ eck this box if tank gauging is used only for inventory control. <br /> Check this box if no tank gauging or SIR equipment is installed. <br /> This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. <br /> Cing checklist: <br /> ❑ Yes ❑ No* Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> ❑ Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> ❑ Yes ❑ No* Was accuracy of system product level readings tested? <br /> ❑ Yes ❑ No* Was accuracy of system water level readings tested? <br /> ET Yes ❑ No* Were all probes reinstalled properly? <br /> ❑ Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> *In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. <br /> ;EJ/Yes <br /> e the following checklist: <br /> ❑ No For equipment start-up or annual equipment c ' ication, was a leak simulated to verify LLD performance? <br /> ❑ N/A (Check all that apply) Simulated leak rate: g.p.h.'; ❑0.1 g.p.h.2; ❑0.2 g.p.h.Z <br /> Notes: 1. Required for equipment start-up certification and annual certification. <br /> 2. Unless mandated by local agency,certification required only for electronic LLD start-up. <br /> S ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> ❑ No Was the testing apparatus properly calibrated? <br /> ❑ No* For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> ❑ N/A <br /> Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> ❑ N/A <br /> Y s ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br /> ❑ N/A or disconnected? <br /> Y s ❑ No* For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions <br /> ❑ N/A or fails a test? <br /> Ej Ye C1 No* For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> ❑ N/A <br /> Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> *In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> H. Comments: <br /> Page 3 of 3 03101 <br />