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Site Address: 5469: 130 S WILSON WAY 95205 <br />F. In -Tank Gauging / SIR Equipment: <br />Date 'esting/Servicing: <br />❑ 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 />This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. <br />f'..,•.rlo+o +lin fnllnwina rl prklict- <br />❑ Yes <br />I ❑ No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />❑ Yes <br />❑ No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />El Yes <br />❑ No* <br />Was accuracy of system product level readings tested? <br />El Yes <br />[] No* <br />Was accuracy of system water level readings tested? <br />❑ Yes <br />❑ No* <br />Were all probes reinstalled properly? <br />❑ Yes <br />❑ No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />* In the Section H, below, descrl"be how and when these deficiencies wore or will be correcte d. <br />G. Line beak Detectors (LIED): ❑ Check this box if LLDs are not installed. <br />es _ <br />Q No* <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br />0 NIA <br />(Checkoff that apply) Simulated leak rate: jg�ag.p.h.l; 0 0.1 g.p.h.2; U 0.2 g.p.h? <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 />Gryes <br />Q No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />es <br />*0 No* <br />Was the testing apparatus properly calibrated? <br />es <br />91 No* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />NIA <br />es <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />p NIA <br />Yes <br />p No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />_ <br />El NIA <br />or disconnected? <br />Yes <br />0 No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions <br />Q. NIA <br />or fails a test? <br />Yes <br />P No* <br />For electronic LLD s, have all accessible wiring connections been visually inspected? <br />Ej NIA <br />Yes <br />❑ No* <br />I Were allitems onthe equipmentmanufacturer's maintenance checklist completed? <br />* In the Section H, below, describe how and when these deficiencies were or will be corrected. <br />r <br />f H. Comments: <br />Page 3 of 3 03.01 <br />