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® 6rrrlFB-RYAN INC. <br />GR Job # 1720- 4947 <br />SWRCB, January 2006 <br />F. In -Tank Gauging I SIR Equipment: ❑ Check 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 />ads® j 7 �� � <br />This section must be completed a in -tank gauging equipment is used to perform leak detection monitoring. T m �, <br />Comolate the follovAna checklist Irl <br />0 <br />Yes, <br />® <br />o <br />Has all input wining been inspected for proper entry and termination, including testing for ground faults? I. <br />❑ <br />Vas <br />® <br />No' <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />❑ <br />Yes <br />® <br />No' <br />Was accuracy of system products level readings tested? <br />❑ <br />Vas <br />❑ <br />No' <br />Wes accuracy of system water level readings tested? _ <br />GNIMENITAI ` <br />❑ <br />Yes <br />0 <br />No' <br />AIR <br />Were all probes minstalled properly? — 1 <br />❑ <br />Ves <br />® <br />No' <br />Were all items an the equipment manufactumfs maintenance checklist completed? <br />in me accts.. n, Mow, describe now and "an mese deficieneles were or will be corrected. <br />G. Line Leak Detectors (LLD): ® Check this box if LLDs are not installed. <br />Complete the followma checklist <br />❑ <br />es <br />❑ <br />o <br />For equipmermt a5 -up or annual equipment oarlificabon, was a talk simulated Venryi LLU peronnance cneck all <br />❑ <br />WA <br />film apply) Simulated leak rate: ❑ 3 g.p.h. ❑ 0.1 g.p.h. ❑ 0.2 g.p.h. <br />❑ <br />Yes <br />❑ <br />No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />❑ <br />Yes <br />❑ <br />No• <br />Was the testing apparatus property calibrated? <br />❑ <br />yea <br />❑ <br />Ne <br />For Mechanical LLDs, does the LLD restict productfiow If it detects a leek? <br />❑ <br />WA <br />EF <br />Ves <br />❑ <br />No' <br />For electronic LLDs, does the turbine automatically shut off ff the LLD detects a leak? <br />❑ <br />NIA <br />No' <br />For electronic LLDs, does the turbine automatically shut off d any portion of vire monitoring system is disabled W <br />❑ <br />WA <br />Disconnected? <br />❑ <br />No- <br />For electronic LLDs, does a turbine automatically shut of if any portion of the monitoring system malfunctions or <br />L11❑ <br />❑ <br />WA <br />rads a test? <br />❑No• <br />or electronic L s, have all accessible wiring connections been visually inspected? <br />NIA <br />• n Me nH1.... <br />❑ <br />Y <br />No* <br />.. ..... <br />were all items on the equipment manufacturers maintenance checklist completed? <br />w , .. n r u _ <br />G. <br />Monitoring System certification Page 3 of 4 12107 <br />3 <br />1 EALTH <br />T <br />