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.0 ouuuHug .,�•dcw l clnnCaltUll <br /> •' FacilityName: <br /> Three Palms Grocery <br /> 1 1 / 21 /02 <br /> F. In=Tank (.auging Equipment: ❑ Check this box it tank gauging is used only for inventory conunl. <br /> This section must be completed if in-tank gauging equipment is used to perlbrm leak detection monitoring. <br /> Software Version Installed: <br /> Complete the foliowin checklist: <br /> ❑ Yes ❑ No* Has all input wiring been inspected Wtionroperly? <br /> ntry and terimnation, including testing for ground faults? <br /> ❑ Yes ❑ No* Were all tank gauging pro es visu Ifor damage and residue buildup? ::A <br /> ❑ Yes ❑ No* Was accuracy of system r duct/ adings tested? <br /> ❑ Yes ❑ No' Was accuracy of system a r le eld? <br /> ❑ Yes ❑ No* Were all slants activat d an di throperly?❑ Yes ❑ No' Were all items on the equipme mas intenance checklist completed? <br /> In the Section H,helow,describe how and when thes deficiencies were or will be corrected. <br /> G. Line Leak Detectors (LLD): 0 Check this box if LLDs are not installed. <br /> Com lete the following checklist: <br /> FOYes ❑ No' Was a leak simulated to verify LLD performance?(Check all that apply) <br /> Simulated leak rate: Cl 3 g.p.h.; ❑0.1 g.p.h.; ❑0.2 g.p.h. II <br /> ❑ 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 /> ❑ No" For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> ❑ N/A <br /> ❑ Yes ❑ 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 /> . . ❑ Yes ❑ No' For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system <br /> ❑ N/A malfunctions or fails a test? <br /> ❑ Yes ❑ No* For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> ❑ N/A <br /> ❑ Yes ❑ Ni • I If necessary to proper equipment operation,are fuel filters in good condition' <br /> ❑ \,'A <br /> ❑ Yes I ❑ 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. J - <br /> H. Comments: r Safe Suction System. <br /> CALM-01 I'age 3 <br />